Page 14 - Wholesale Buying Club Catalog 2017
P. 14
Wholesale Buying Club
POS Merchandise Order Form - Page 1 of 2
Please fax completed form to 866-559-4901 or email: jph@creditacceptance.com to place your order.
SHIPPING ADDRESS Check here if shipping and billing are the same.
Dealer Name: Lot #:
Name:
Address:
City: State: Zip:
Phone:
Email Address (need for receipt):
BILLING ADDRESS - WHERE CREDIT CARD STATEMENT IS MAILED
Address:
City: State: Zip:
METHOD OF PAYMENT: MC VISA AMEX DISCOVER
Account Number:
Expiration Date: (MM/YY) CVV:
