Credit
When Credit is Due
(ORDER FORM)
|
Name: _______________________Phone:
__________________
Address:
______________________________________________
City: ___________________, State: _______
Zip: ___________
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Ship
to information (if different)
Name:
_______________________________________________
Address:
_____________________________________________
City; ____________________, State: _______
Zip: ________
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Preferred Payment Method
(The
total cost for this course is $50,
(this includes shipping and handling).
ACH
(automatic withdrawal from my bank account) Fax to 877-697-7947
_ _ _ _ _ _ _ _ _ _____________________
Routing Number Account Number
I authorize Auriton Solutionsâ to debit $50 from my bank
account referenced above upon receipt of this authorization. I have attached a voided check for
processing.
Draft Check (check
created with my account information) Fax to 877-697-7947
_______________________ ____________________
Bank Name Bank Phone Number
_ _ _ _ _ _ _ _ _ ___________________ _______________
Routing Number Account Number Check Number
By
signing below, I authorize Auriton Solutionsâ to create a draft check and
present it for payment on my bank account referenced above. I am aware that I must record this check
number in my register for the check that Auriton produces will clear my account
in its place. I have attached this voided check for processing.
Credit Card: Fax to 888-657-5559
MasterCard
Visa
American Express
Discover
___________________ ______________________ ______________
Name
as it appears on Card Account Number Expiration Date
_______________________________________________ __________________
Signature Date
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For internal use only
Date order received: Date Shipped: Book #:
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GAF-75-15 Rev B