Credit Card Authorization Form
Credit Card Authorization form: Download PDF File and email to sales@hdhinc.com
SHIPPING INFORMATION:(all fields are required)
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Company/Name: |
Contact: |
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Phone: |
Email: |
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Shipping Addr: |
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City: |
State: |
Zip: Country: |
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ORDER INFORMATION: (attach 'Online Shopping Cart' or 'Estimate' if available)
Prices are subject to verification
| # | Item ID | Description | Finish/Style | Qty | Unit Price | Total Price |
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Sub-Total |
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PA Residents Add 6% Sales Tax |
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Shipping & Handling |
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GRAND TOTAL |
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BILLING INFORMATION:(all fields are required)
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Credit Card Type: |
Visa | MasterCard | Amex | Discover |
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CC Number: |
Exp Date (mm/yy): | |||
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Owner's Name: |
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Billing Address: |
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City: |
State: | Zip: | ||
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Signature: |
Date: | |||
If you are paying by "CHECK", please mail your check to:
Home Decor Hardware, Inc., 200 S. Franklin St # 8D, West Chester, PA 19382
COMMENTS: (please provide additional information if
necessary)
