Tampa, FL: 2400 S. Gelman Place, Tampa, FL 33619 Ph. (813) 644-6880– Fx. (813) 644-6875Credit Card Authorization Form • December 2nd, 2016
Contract Type FiledDecember 2nd, 2016*By inserting your legal name, you are signing this agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this agreement. By inserting your legal name, you consent to be legally bound by this agreement’s terms and conditions.