CASH SALES / TELEPHONE / FAX - CREDIT CARD AUTHORIZATION

CUSTOMER NAME: PHONE: FAX:

I AUTHORIZE FLORIDA METAL CRAFT, INC. TO CHARGE THIS
CREDIT CARD, AND/OR ANY OTHER CREDIT CARDS I PROVIDE THEM.

CUSTOMER ORDER:     FMC WORK ORDER:


CREDIT CARD INFORMATION & BILLING ADDRESS
(As it appears on your credit card statement)

TYPE: VISA     MASTERCARD     DISCOVER     AMEX CARD NUMBER EXP DATE:     CODE: NAME ON CARD
DATE	ADDRESS City, State ZIP

CARD HOLDER - PRINT FORM, THEN SIGN THIS BOX BELOW
CARD HOLDERS Signature Here