Kelly M. Flory 4327
Munjar Road, Chico, California 95973
Phone: (530) 899-8990 | Fax: (530) 899-8980 | Email:
Authorization for Credit Card Charges
This document is intended to authorize Cornerstone
Kennels to process the following credit card charges:
INSTRUCTIONS FOR COMPLETING THE SALES
1. Before printing, please select all
appropriate categories for
from the drop down lists below.
2. After you have made your category selections,
Print This Page.
3. Complete ALL remaining information before submitting by
For PRINTED NAME: The Cardholder's
name must be written exactly as it appears on the card. If the Cardholder
is someone other than the Customer, please include the Customer's name in
the information space provided below the sales slip.
*FOR CK USE ONLY. PLEASE LEAVE THESE
__ __ __ __-__ __ __ __-__ __ __ __-__ __ __ __
CUSTOMER INFORMATION: If other than the
CARDHOLDER INFORMATION: Please include
the billing address for the account being charged.
City, State &
By completing this document and returning it in addition to your deposit
agreement &/or your shipping addendum, the Cardholder authorizes Cornerstone
Kennels to make charges to the above listed credit account. "Balance Due"
payments made by credit card include a processing fee not associated with
payment made by cashier's check, money order or cash. "Shipping Fees" paid
by credit card will not include additional processing fees. We will not process
this form or make charges to any credit card without the accompaniment of
the appropriate documents of agreement.