NT Trading Inc. CC Auth Form

Sign and complete this form to authorize the merchant below to make a one-time charge to your Credit
Card listed below.

By signing this form, you give us permission to charge your account for the amount indicated on or after
the indicated date. This is a permission for a single transaction only, and does not provide authorization
for any additional unrelated debits or credits to your account.

Company Name *

Name on Card *

Billing Address *

Zip *

Invoice/Pick List Number *

Card Type *

Credit Card Number *

Expiration * 🛈

CVV *

Amount to be charged *

Email Address *

Phone *

I authorize NT Trading Inc. to charge my card *

Yes

Signature of the Card Holder *

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