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Credit Card Authorization
Card Type
(Required)
MasterCard
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Other
Cardholder Name (as shown on card)
(Required)
Company Name
Credit Card Number
CVV
CVV
Expiration Date (mm/yy)
Cardholder Zip Code (from credit card billing address)
Amount Authorized
Sales Order or Purchase Order Number
Customer Number (if applicable)
Consent
I authorize this card to be used by Century Metals
I authorize Century Metals to charge my credit card above for agreed upon purchases. I understand that my information will be saved to file for future transactions on my account.
Signature Date
(Required)
MM slash DD slash YYYY
Signature
(Required)
Authorized Pickup Agent
First Name
Last Name
Valid Identification card of CARDHOLDER and PICK UP AGENT required