Credit Card by Mail

KEJO LIMITED COMPANY

1201 S Highland Ave

Suite 6

Clearwater

Fl 33756

Tel 1-7274433455

Fax 1-7274435184

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

Card Number:__________________________________________

Expiry Date mm/yy:_______/_______Card Security Code _________

Cardholders Name______________________________________

Billing Address__________________________________________

                         ___________________________________________

                         ________________________________________

                         _________________________________________

Shipping address if different:_____________________________

                                                  _____________________________

                                                 ______________________________

Telephone number: _____________________________________

Printed Name:         ______________________________________

Amount                     $____________________

Signature of Cardholder________________________________

Date:                          _____________________

****Please provide us with a legible copy of the front and back of credit card.  Fax to 1-727-4435184.

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

Thank you for your cooperation.