Credit Card Authorization – Audio Realignment

Company Name: *

Business Address: *

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Address Line 2

City

State

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Phone: *

Dealer E-Mail: *

Name as it appears on Credit Card: *

Credit Card Billing Address: *

Address Line 1

Address Line 2

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State

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Card Number: *

Exp. Date: *

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CVV *

Credit Card Type: *

Authorization *

I authorize Audio Realignment Technologies (A.R.T.) to keep my credit card number on le and to charge this card whenever a new order of product(s) has shipped along with shipping costs. * All orders placed with A.R.T. shall be presumed delivered and received in satisfactory condition unless A.R.T. is noti ed in writing within ve (5) business days of delivery.

Acknoledgement *

By signing this form, I acknowledge that Audio Realignment Technologies ships all products via USPS Priority Mail unless another preferred carrier and/or service is speci ed at the time of the order. Relevant tracking and/or order information shall be provided at the time of shipment.

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Name (Printed): *

Date *

Signature *

Clear Signature

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