Credit Card Authorization Form

This document authorizes INFOTECH USA, INC., or its affiliate to charge your credit card for payment.

Cash Type:



Billing Address (As appeared in credit card statement):

Shipping Address (If different then billing):

Qty

ISBN (Book #)

Name of Title & Author

Each Price

Amount

(New York residents, please add 8.65% Sales Tax)

Shipping charges: (Add $8.95 for first book and $1.95 for each additional book)

I agree to pay the above charges according to the card issuer’s agreement. I understand that my signature on this contract will serve as my authorization on the credit charge slip and as a signature on file for all authorized charges and outstanding balances now and in the future. As registered user of this credit card, I authorize INFOTECH USA, Inc., to ship this order to address requested on my order, and I am responsible for any person receiving this order, if selected the different address then billing address.

"I Understand That Using A Credit Card Fraudulently Is Illegal And Charges Will Be Pursued To The Full Extent Of The Law."

Please fill in all the fields, print, sign, date and fax to 516-568-0566

If your shipping address is in New York state and you are tax exempt, please fax a copy of tax exempt certificate with this form.