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Crown - Credit Card Processing

The document is a request form for a company to provide credit card information so that Crown Lift Trucks can process payments for parts, service, and rentals on their behalf. The form requests the credit card number, expiration date, CVV number, cardholder name and signature, billing address, contact information, customer number, receipt preferences, and an authorized representative's information.

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Ebenezer Frimpong
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© © All Rights Reserved
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164 views1 page

Crown - Credit Card Processing

The document is a request form for a company to provide credit card information so that Crown Lift Trucks can process payments for parts, service, and rentals on their behalf. The form requests the credit card number, expiration date, CVV number, cardholder name and signature, billing address, contact information, customer number, receipt preferences, and an authorized representative's information.

Uploaded by

Ebenezer Frimpong
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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To: Accounts Payable/___________

From: Crown Lift Trucks; Accounts Receivable Department

Re: Request to Process Payment via Credit Card

Date:

Please fax or email in an Excel or Word document that is password protected the following
information ​to ___(Crown Rep name & email)__ as soon as possible at 419-629-6317.

Please do not send the password via email for security purposes. We prefer that you call us with the
password. Credit card payments cannot be processed until this information has been provided.

Thank you for your cooperation and your business.

(Business)___________________________ would like Crown Lift Trucks to process credit card payments
for parts, service and rental invoices issued to us.

_____ __x____ _______ ______

Credit Card # 5572 6700 0021 0911 Expiration Date 06/24

CVV# 931 Cardholder Names as it appears on the card: Ebenezer Frimpong

Cardholder Customer Signature ______Ebenezer Frimpong________________________________

Billing address on the card: 200 Brackbill Ct Pickerington, OH 43147

Billing address (cont.) ____________________________________________________________________

Phone Number___________________________ Fax #____________________________

Crown Customer number _________________

Do you require an email receipt __X___ Yes _______ No Email address _______________________

Process the charges individually ________ or as a Lump Sum ___X_____ (Please check the appropriate
box)

Customer Representative who is authorized on behalf of the Company to submit the request

(Please Print) ______________Ebenezer Frimpong________________

Signature________Ebenezer Frimpong____________________________________________

Title ___Co-Founder_____________________ Date____08/06/2020

Note: This form will be kept for 1 year beyond the expiration date

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