Credit Card Payment

Please print this page, fill in the information and fax it to AMC

1.   Credit card type    Master Card________    OR      Visa__________

2.  Credit Card ________________    OR        Debit Card______________

3.  Credit Card Number ____________________________________________________________

4.  Name as it appears on the card __________________________________________________

5.  Expiration Date     Month_________     Year_____________   

6.  Three Digit Code on the back of the Card __________________

7.  Billing Address for the card





8.  Phone Number _________________________________________

9. Charges will be for engineering time plus expenses that may include administrative fees.  All Charges will be in US Dollars.  There are NO refunds for time spent, work in progress, or minimum charges.  If the client requests a stop work we will endeavor to reduce additional expenses.

Authorized to proceed not to exceed $_______________________________

Signature_______________________________________   Date_____________________________



FAX completed form to CompanyFAX

Contact Information: 

407-880-4945 -------- (Consulting is only available for customers)
Postal address  
Electronic mail
General Information:
Customer Support:  

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Copyright 1999 Robert McCabe                    
Last modified: February 17, 2015