592 Apollo Street, Brea, CA 92821 Sales: (714) 990-2300 Fax: (714) 990-3303
CREDIT CARD AUTHORIZATION
ALTINEX - END USER NAT'L
Your completion of this authorization form will help us to protect you, our valued customer, from credit card fraud. All information entered on this form will be kept strictly confidential.
Please fill out the form completely and accurately. We reserve the right to verify the provided information with your Credit Card issuing bank. We are not responsible for delays due to missing or improper information.