CREDIT CARD SIGNATURE ON FILE AUTHORIZATION
_________________________________________ authorizes to AVAD Southeast, LLC. the use of the
purchasing/credit card listed below for approved purchases. This authorization will serve as
“Signature on File” on all transactions.
Authorization will remain in effect until cancellation is made by either party.
All purchasing/credit card information will remain confidential and will not be released to any
unauthorized party.
__________________________________________________
Company Name
___________________________________________________________
Purchasing Credit Card Type
(Visa, MasterCard or American Express)
___________________________________________________________
Purchasing Credit Card Number
___________________________________________________________
Expiration Date
___________________________________________________________
Name As It Appears On Card
___________________________________________________________
Billing Address
___________________________________________________________
Billing City, State & Zip Code
___________________________________________________________
Authorized Signature
□ Replace All Other Cards on File
□ Add As Primary Card on File
□ Add As Additional Card on File
□ One Time Use ONLY for______________________________________
*Check One Above
AVAD, 5000 Highlands Parkway Suite 280, Smyrna, GA 30082
Phone: 770-434-7242 · Fax: 678-909-4147
us.avad.com