Send Form, and copies of credit card and I.D. to Los Angeles
Furniture Online via:
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Credit Card Holder Name
*The address entered must match the address
where the credit card bill is received
Credit Card Billing Address
City
State
Zip Code
Phone
Fax (If Applicable)
I am charging the following
products to this credit card:
Credit Card Type (Circle one)
Visa · Master Card · Discover
Credit Card Number
Credit Card Expiration
Charge my card the following amount
I, the undersigned, do hereby authorize Los
Angeles Furniture Onlineto charge the above card in the amount indicated above.
I am signing below, acknowledging that I am the cardholder under
penalty of law.
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