Vendapin L.L.C.
Vending Cash & Credit Card Cost Recovery Payment Stations & other Vending Controls or Software,
Telephone: [1] 352-796-2693, [1] 352-279-7727, Fax: [1] 775-256-6311
Manufacturing & Technical Support: [1] 352-277-8179, [1] 352-678-3021, [1] 352-678-3027

Visa, MasterCard & American Express Credit Card Purchase Order Form Application Compre con Tarjeta de Credito   VERIFICATION FORM FOR CREDIT CARD CHARGES Please note that the bill to of the credit card holder must be the same or additional billing information must be submitted below:       From:   COMPANY NAME:_________________________________________   DATE: _______________  (Note: Maximum Credit Card Approval is $2,500.00)                                 CARD HOLDER NAME: ________________________________________                                  CARD NUMBER:  _________________________________   EXPIRATION DATE:  _______________                                 BANK NAME ON CARD: ___________________________  TYPE OF CARD:  ___________________   CARDHOLDER BILLING ADDRESS: _____________________________________________________              I _________________________________________________(cardholder name, please print)  authorize VENDAPIN LLC to charge the order I placed under _________________________________(company name) on the above referenced credit card account.    SIGNATURE OF CARD HOLDER: __________________________________ SECURITY CODE: ________   AUTHORIZED AMOUNT:  Merchandise                 $_____________________________ (freight charges are additional) FREIGHT CHARGE: $ _________ US                :                TOTAL CHARGES: $ _________ US (Equal to Overnight Shipping and Handling Charges) VERIFICATION / AUTHORIZATION NUMBER:                ________________________________ (for office use only) We. at VENDAPIN L.L.C., are requesting this form to be filled out to protect our customers from incorrect or fraudulent charges to their credit cards. This form will help us to insure correct information and verification before any transaction has occurred. Please read and check all information before you fax this form back to us.   Return this approved credit card agreement to Diane L. Rademacher, VENDAPIN L.L.C., Fax: 775-256-6311 or 775-514-7530.  Telephone: (352) 796-2693 Thank you for your cooperation. Diane L. Rademacher Director of Finance VENDAPIN L.L.C.  contact you back within 24 hours with your Todos los espacios tienen que ser completados.  Si tiene problemas, llame al (352) 796-2693 o envie un fax al (352) 256-6311 .  Nosotros nos comunicaremos con usted en 24 horas despues de la aprobacion para darle fecha de envio. Contact (Comuniquese): e-mail