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2017 SEAWIDE DISTRIBUTION CATALOG

41698 Eastman Drive, Murrieta, CA 92562 Phone: (949) 515-5360 Fax: (951) 600-8530 CREDIT CARD AUTHORIZATION Must be completed if you are using a credit card* www.seawide.com I, (Print Name) ___________________________________, do hereby authorize Seawide Marine Distribution to charge the following credit card for purchases made under the customer name of __________________________________________. Card Type Visa MasterCard American Express Name printed on card _______________________________________________________Company Card Yes No Phone _____________________________ Email Address ________________________________________________________ Security Code #: Code must be provided at time of order (3 digits V/MC – 4 digits AMEX) Card #____________________________________ Expiration date _______________________ Card Billing Address __________________________________ City __________________ State _________ Zip____________-________ Your card will be kept on file for future orders unless you specify that this is a one-time credit card authorization. Check box if card authorized for one time use only Invoice # or Sales order # ____________________________________ Include copy of photo ID and back of credit card here *Credit card cannot be used to make payments on product ordered on net or discounted terms. *Third Party credit cards will not be accepted. Authorized Signature/Cardholder ______________________________ Title __________________ Print Name ________________________________________________ Date __________________ (Please SIGN and PRINT name above. NOTE: Signature Must Be Authorized Cardholder)


2017 SEAWIDE DISTRIBUTION CATALOG
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