Page 68 - KNA Supply Pro-Shop Catalog 2024

KNA CREDIT CARD AUTHORIZATION

AUTHORIZATION TO CHARGE CREDIT CARD

COMPLETE AND SIGN THIS PORTION TO AUTHORIZE KNA SUPPLY TO CHARGE YOUR CREDIT CARD.
I _____________________________________ hereby authorize KNA Supply to
(Print Your Full Name)
charge the following credit card:
Account Type: AMERICAN EXPRESS VISA MASTERCARD

Account Number:
__________________________________________________________________________
Expiration Date: ________________________ Validation Code (CVV2): __________

Cardholder Name:___________________________________________________________

Billing Address:______________________________________________________________

City: ____________________ State: __________________ Zip Code: __________________

Business Name: _____________________________________________________________

Business Address: ___________________________________________________________
(4 DIGITS ON
City: _____________________ State: _________________ Zip Code: __________________

For The Amount Of: (U. S.) $ ______________ Payment of Invoice #:___________________

SIGNATURE: ______________________________________ DATE: ____________________

PRINT NAME: _______________________________________________________

TITLE: _____________________

AUTHORIZATION TO KEEP CREDIT CARD ON FILE

COMPLETE AND SIGN THIS PORTION TO AUTHORIZE KNA SUPPLY TO KEEP YOUR CREDIT CARD ON
FILE FOR FUTURE PAYMENTS.
I _____________________________________ hereby authorize KNA Supply to
(Print Your Full Name)
keep the above credit card on file
SIGNATURE: ________________________________________ DATE: _________________

PRINT NAME: _______________________________________ TITLE:__________________
PLEASE FAX THIS AUTHORIZATION WITH A VALID FORM OF PICTURE ID.
KNA Supply
PO Box 771826, Ocala, FL 34477 • TEL: (352) 351-1170 • FAX: (352) 351-2600 • www.knasupply.com