By my signature below I, ______________________________ authorize CompFLorida Inc, to bill my credit card for product or services:
Name of Credit Card: [ ] Visa / [ ] MasterCard / [ ] American Express / [ ] Discover
Date: ______________________
Print Full name as shown on card : ___________________________________
Credit Card Address : ____________________________________________
Card Number : ______________________________________Zip :___________
Expiration date on card: _________________________
CVV code: _______________ (on back of card, in signature field)
Card Holder signature: _______________________________________
[Initals] ____ I understand that the amount charged to my credit card will be reflected on my credit card statement within seven days of autorization. The amount charged is based on services/product (s) requested by me.
CompFLorida, Inc
6920 NW 25 St Sunrise FL 33313
Tel (954) 742-6673 | Fax (954) 337-0148
Email: mail@compfl.com | www.compfl.com