I hereby authorize CarFix Auto Parts to charge
my credit card as follows:

Master Card
Visa
American Express
Discover

Card Number:

Expiration date:


(Last 3 digits shown on the back of your card) :


Credit Card Billing Address:


Shipping Address:
:

Name as it appears on the card:


Cell Phone:


Home Phone:


E-Mail:

Card holder's signature

Date


PLEASE SEND A COPY OF YOUR CREDIT CARD AND PHOTO I.D.
I hereby certify that the above statements & information are true and correct to the
best of my knowledge. I also certify That I am authorized to effect charges to the
above card.

Amount to be charged:

Year:


Make:


Model:


Description of the part:


Sales personís name:


Comments


I hereby certify that any and all charges in connection with this credit card transaction will be billed and charged to the above listed account. I agree that I will not initiate a Charge Back for this transaction and future transactions in conjunction with this purchase. I release CarFix Auto Parts for any and all liability in obtaining payment for any purchase or charge made. Any disputes will be brought to the attention of CarFix Auto Parts for refund or credit and all decisions of CarFix Auto Parts are final and binding. I relinquish my rights to charge back any amount charged on my credit card confirm that I am liable for all fees associated with such transaction