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Credit Card Authorization Form

Complete, sign and return this Credit Card Authorization. This credit card authorization will be used only for the payment of the specified transaction. All information is strictly confidential and will be kept in the files of MultiSol.
All the information that you exchange with MultiSol will now travel encrypted (encrypted).
Company Name: *
Multisol Sales Representative: *
Multisol Sales Transaction #:
This credit card authorization is for payment of equipment and/or services purchased from Multisol LLC.
Credit Card Billing Adress:

Order Ship-to Adress:

Name on Card: *

Street #1: *

Street #2:

Country / City / State / Zip: *

Phone: *

Credit Card #: *

Expiration Date: *

Security Code: *

Credit Card: *

AMEXVISAMASTER CARD



NOTE: Additional 3.5% Charge will be added for processing fees.

Company Name: *

Street: *

Suite / Bldg:

Country / City / State / Zip: *

Phone: *

Purchase order number: *

Attach Copy of Buyer's Purchase Order:

Attach Multisol Sales Agreement:

Must Attach Copy of Buyer's Purchase Order
Must Attach Multisol Sales Agreement Signed

Subtotal: $ *
Taxes:$
Freight:$
Credit Card Fee:$
Total:$

By submitting this form you are agreeing to the terms of the sale and you authorizing Multisol LLC to charge your afore mentioned credit card for the amount indicated above.

All purchases are final . No chargebacks are allowed. For any warranty issues you must contact MultiSol.