MONITOR DEPOT, INC
5359 West Richey Road Houston, Texas 77066
(281) 580 - 5656 After Hours (281) 450 - 1064
Mon - Thurs 9:00 - 5:00 Friday 9:00 - 3:00
CREDIT CARD INFORMATION SHEET
Note: Print this form and then complete by hand.
(The credit card will not process if the billing address is not correct, and will result in shipping delays)
Please print neatly
Name on Card : __________________________________________________
Billing
Address for the card:
_______________________________________
City:
Type of card:
VISA
MC
DISCOVER
Credit Card
Number: _________
_________ _________
_________
3 Digit Code on back : _______
Expiration: Month: _____ Year : _____
I authorize
$ ____________ for the repair, plus shipping charges.
Signed:
______________________________