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| Listing #: | _________________________________________________ | |
| Company: | _________________________________________________ | |
| Credit Card Billing Address: | _________________________________________________ | |
| _________________________________________________ | ||
| Ship To Address: | _________________________________________________ | |
| _________________________________________________ | ||
| Internet/E-Mail Address: | _________________________________________________ | |
| Tax ID#: | _________________________________________________ | |
| Name: | _________________________________________________ (If ordering as a business, please provide Authorized Representative's name) |
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| Title: | _________________________________________________ | |
| Phone: | _________________________________________________ | |
| Fax: | _________________________________________________ | |
| I have read and agree to the
Sales Terms and Conditions and I authorize NYCT to charge the following credit card in the amount of:
Signature: _______________________________________ Date: __________________ |
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|
Credit Card # (Mastercard or Visa Only) |
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| ____________-___________-___________-___________ |
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| Expiration Date________/_______ |
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| Division of Materiel - Operations - Asset Recovery, 2 Broadway, 18th Floor, Room A18.71, New York, NY 10004. Phone: 1(800) 543-VALU; Fax: (646) 646-252-6017. |
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