BOSS AUDIO SYSTEMS User Manual

A

N

A

_

CLEAR FORM

3451 Lunar Court, Oxnard, CA 93030

TEL: [phone] FAX: [phone] NTL: [phone]

www.bossaudio.com

Please fill out completely, and Fax it to [phone]

I ______________________________ (name) acting as __________________

(job title) o

f

___________________________ (business name), give BOSS AUDIO SYSTEMS permission to

charge my personal or Corporate Card (4 digit Customer Code is required __________)

Visa MasterCard security code _________ (Last 3 digits on the back)

American Express security code _________ (Non-raised 4 digits on the front)

ccount # _________________________________________________ Expiration date _____/_____

Card Holder Billing Information: Phone # _________________________

ame on card ________________________________________________

ddress _____________________________________________________

City ______________________________ State _______ Zip Code _________

Please consider this single form to be authorization for all future purchases

.

I will fill out an authorization form each time I make a credit card purchase. For the amount of

$ ______________ order placed on ___________________ (date)

______________________________________

Authorized Signature

SHIPPING ADDRESS IF IT’S DIFFERENT: PHONE #: __________________________________
NAME ___________________________________________

STREET __________________________________________

CITY __________________________________ STATE __________ ZIP CODE ______________

FOR ORDERING PARTS: PRODUCT MODEL# _____________ PART# ____________

DESCRIPTION