authorize-card - Leading Edge Novelty

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Credit Card Authorization and Verification Form
Tel: (516) 484-4177 * Fax (516) 454-0500
33 North Mall Plainview, NY 11803, USA
sales@leadingedgenovelty.com

Yes *

I authorize to use my credit card for purchases from Leading Edge Novelty, Inc.

Buyer Name *

Company *

Order Number *

Select Date *

Please accept this letter as authorization to bill my credit card for all charges pertaining to the order above. *

This order only (We will request this information with all orders even if using this card again).
Until further notice

Enter Card Holder Name *

Address *

Credit Card *

Type of Card: (Check One) *

MC
Visa
AE
Discover

Expiration date *

CVV CODE *

Fax

Telephone *

Email Address *

Phone

leadingedgeauthorize-card07.06.2020