Credit Card Payment Authorization Slip

Today’s Date __________                Amount to be charged $_________________________

Company/Name _____________________________________________________________

                                                         (As it appears on your invoice)

Card Holder’s Name _________________________________________________________
                                                                (Please print as the name appears on the credit card)

                                                         We Accept These Cards:
                Discover Card____  Master Card____ Visa____  American Express____
                                                (Please place an X next to the Credit Card)

Credit Card # ________-________-________-________               Expires _____/_____

3 Digit Security Code __ __ __

Card Holder’s Signature ______________________________________________________

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                                                                      For eBay Purchases

Item # ______________________________

Item Name: _______________________________________

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Note: please send this slip to:     Surplus City

                                                            4514 Pacific Heights Rd

                                                            Oroville Ca 95965

                                                            (530)534-9956
                                                            (530)534-1170 (fax)

Please print this form and mail or fax it to us.                                                            Thank you