?@

12185-86th?@Avenue Surrey?@B.C. V3W 3H8 Canada
TEL (604)591-5386?@FAX (604)591-8479

Credit Card Payments Authorization Form
?i?J?[?h?ø?«???Æ?µ?3?ø???j
?@
I,
?iPlease Print Name?j???[?}???Å?J?[?h?É?L?Ú?3?ê?Ä?¢?é?Ê?è?É?¨?¼?O??L?ü?º?3?¢
of
(Address) ?2?Z??????[?}???Å
?@
?@
?@
(City/Province)?s?A?s?A?{ (Postal Code)?X?Ö?Ô?? (Telephone)?d?b?Ô??
have given Merit Kitchens Ltd. authorization to pay my account:
?????b?g?L?b?`???Y?ª?È?º?Ì?ø?«???Æ?µ??s???±?Æ??3?ø?·?é?B
(Customer Code)?¨?q?l?R?[?h ?@ ?@
?I?[?_?[?m?F???E?ã?Ì?V?¶???Ì?A???t?@?x?b?g?R?[?h
?@
(Invoice Number)?W???u?i???o?[
?@
 ?@
?I? |?_?[?m?F???E?ã?Ì?O?Q?Å?n?Ü?é?????V???Ì?Ô??
in the amount of CDN$
?@
 ?@
?à?z ?i?J?[?h?Ì?????ã?À?à?z?É???Ó?j
Please charge payment to my ?  VISA or ?  MASTERCARD NUMBER
?J?[?h?¼?É?`?F?b?N?}?[?N
?@
(CARD NUMBER) ?J?[?h?Ô???i?Å???Ê?è?S???L?ü?j (EXPIRY DATE) ?L?ø?ú?À?i?J?[?h?Ì?Å???Ê?è?É?j
SIGNATURE?i???¼?j
?@
 ?@ DATE?i?ú?t?j
?@
?@ ?@

?@
?@ l>