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 ______________________________________________________


                                                                      For eBay Purchases


Item # ______________________________

Item Name: _______________________________________


Note: please send this slip to:     Surplus City

                                                            4514 Pacific Heights Rd

                                                            Oroville Ca 95965

                                                            (530)534-1170 (fax)


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