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Business Credit Card Authorization Form

Audio Video Service Labs
829 Lynnhaven Pkwy Ste 128
Virginia Beach, VA 23452

CREDIT CARD AUTHORIZATION

This is to authorizate Audio Video Service Labs Labs Inc. (a Kenwood Authorized Service Depot) to charge all repairs for (Business Name) ___________________________________________ to

(Personal Card / Business Card) Visa / Master Card / American Express / Discover number ________________________________________________

Exp Date _____________

CVV2/CVC2/CID Number____________ (See back of credit card)

Billing Name:

Billing Address:

Billing City / State / Zip:

Please ship my product as follows:

(You need not complete this section if the shipping address is the billing address.)

Shipping Name:

Shipping Address:

Shipping City / State / Zip:

Signature of Credit Card Holder: ___________________________________________________

Print Signature Name:____________________________________________________________

Date:

Fax Reply: (757) 340-6809

WE DO NOT ACCEPT DEBIT / CHECK CARDS for mail order sales. I understand that all parts sales are final.