[. . . ] [. . . ] I will fill out an authorization form each time I make a credit card purchase. For the amount of $ ______________ order placed on ___________________ (date) _______________________________________ Authorized Signature SHIPPING ADDRESS IF IT'S DIFFERENT: PHONE #: __________________________________ NAME ___________________________________________ STREET __________________________________________ CITY __________________________________ STATE __________ ZIP CODE ______________ FOR ORDERING PARTS: PRODUCT MODEL# _____________ PART# ____________ DESCRIPTION [. . . ] [. . . ]