Credit Card Payment Form
Please print this page then fill in all the requested information and fax to Fire Busters at 604-599-4319. If you have any questions, please contact us 604-599-4499 or email us.
PLEASE NOTE: Name, Address & Postal Code MUST match EXACTLY as per credit card statement from your bank or financial institution!!
Card Holder Name:_____________________________________
(Must be exactly as per credit card)
Address:_____________________________________________
(Must be exactly as per credit card statement)
City:________________________________________________
Province: _B.C_____________ Postal Code:_________________
Phone:_____________________ FAX: _____________________
Payment to account of :_________________________________
Payment Amount: $____________________ Canadian Currency
Type of Credit Card: Visa or Master Card
Credit Card #___________________________________________
Expiry Date:____________________________________________
I Authorize Fire Busters Inc. to charge my credit card for the amount indicated above.
__________________________________
Signature of Card Holder
_____________________
Date
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