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          Specials
          BED BUG PROTECTOR
          Can Liner
          New Product - NOW AVAILABLE
          Paper Products
          Ashtray & Chemicals
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          Non-Logo Products Cont.
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      New Customer Form | Credit Card Payment Form | Order Form | Shipping and Customer Service | Contact
    Search : Advanced Search        View Cart
    Payment by Credit Card Form
      Company Name:
      Corporation Name:
      Address:
      City:
      State:
      Zip:
      Phone #:
      Fax #:
      Invoice #   Total  
      Invoice #:        
      Invoice #:        
      Invoice #:        
      Invoice #:        
      Invoice #:        
      Credit Memo (If any):        
      Total of all invoices:    
    Credit Card Information   
     

    Type of Credit Card: Master Card, Visa, Discover, American Express
     

    C.C. #:

    		 
     

    Billing Address:

    		  
     

    City:

    		 
     

    State:

    		 
     

    Zip:

    		 
      Amount you want us to change:  
     
      Signature: ___________________
           
      Important Notice
      If any dispute in the invoice please do not just deduct the amount. Send us the copy of the invoice and let us know why the money is being deducted. If any deduction taken without proper paperwork, your account will get put on either COD payment terms, if not your signature will be required to approve all the prices and orders, before it’s shipped; which could delay the shipment.
    Please print, and complete the form. Fax it to us @ 214-745-8876
    © Copyright DFW Motel Supply 2007   New Customer Form | Credit Card Payment Form | Order Form
    Shipping and Customer Service Form | Contact     		Website Developer : iFlair Technologies