Date _____________

I, ____________________________ hereby authorize Fran Auto Sales, to charge my credit card account

to the amount not to exceed: $_________________

( ) Visa                        ( ) MasterCard             ( ) American Express               ( ) Discover

Credit Card Number: ________________________________________

Expiration Date: _____________________________CV Code: _______

Credit Card Billing Address: 

Street: ____________________________________________________ 

City: _____________________________ State: ___________________ 

Zip Code: _______________ Country (if not USA):________________ 

Telephone: (____) __________________ 

Requested Shipping Address (if different from billing): 

Street: ____________________________________________________ 

City: _____________________________ State: ___________________ Zip Code: ______________

Country (if not USA): _________________     Telephone: _______________________

There is no warranty on electrical parts and they cannot be returned. All other parts are warranted for 30 days from the date of purchase and must be returned in the same condition as when sold in order to receive credit. No refund for shipping cost. A 4% for credit card processing will be charged to your total.

By signing I verify that I am the Authorized user of this credit Card 

_____________________________________                                  ____/____/____

Cardholder’s Signature                                                                       Date

Fran Auto Sales will keep all information entered on this strictly confidential. 

FAX COMPLETED FORM TO (305)-885-0559, including a copy of your credit card and driver’s license. Thank you!