MAYFAIR PAINT SECURE PAYMENT FORM

CREDIT CARD PAYMENT FORM

Sign and complete this form to authorize MAYFAIR PAINT N PAPER LTD. to make a one time debit to your credit card listed below. By signing this form you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.
Company Name
Company
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
ACCT NUMBER or INVOICE NUMBER

Please enter your account or order number if known
PLEASE ENTER ANY NOTES , COMMENTS HERE.
ENTER AMOUNT TO PAY
Total
$ 0.00 CAD

Credit Card

Card Details

Cardholder Name

I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.