KEJO LIMITED COMPANY
PO Box 7936
Fax 1-727-472 8114
Credit Card Authorization Form
I hereby authorize Kejo Limited Company, to charge my credit card for goods I have ordered as per their Invoice
Type of card Circle one: American Express/Discover/MasterCard/Visa
Expiry Date mm/yy:_______/_______Card Security Code _________
Shipping address if different:_____________________________
Telephone number: _____________________________________
Printed Name: ______________________________________
Signature of Cardholder________________________________
****Please provide us with a legible copy of the front and back of credit card. Fax to 1-727-472 8114
Cards cannot be processed without copy and authorization forms signed and dated.
All copies of credit cards will be destroyed within ninety (90) days of processing.
You can also mail this to the address above or FAX to 1-727-472 8114
Thank you for your cooperation.