CREDIT CARD AUTHORIZATION FORM PLEASE COMPLETE THIS FORM
TO PAY FOR YOUR TRANSACTION BY CREDIT CARD
Just fill out this form, print it, sign it and send it to us (mail, email, or FAX) or bring it in to one of our locations. Please don’t forget to include an image of your driver’s license.
Fax: # 502-400-5933, Attn: Elizabeth Llamas
Email with signed application and driver’s license image to: Elizabeth Llamas, firstname.lastname@example.org
ATTN: Accounts Receivable Department
ALGAR, Inc. d/b/a Grade A Allstate Auto Parts
7301 Grade Lane, Louisville, KY 40219