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 China Pearl Import
CPI Center
10220 Norris Ave.
Pacoima, CA 91331
Phone:  (818) 249-9888 Fax:  (818) 249-4777
DATE: //

CREDIT CARD AUTHORIZATION
Please fill out form, print and fax to (818) 249-4777
Invoice # / Sales Order#:

Master Card  Visa
Amount Authorizing:

  Amount:
$

  Initial:
Company Name:
Credit Card Holder:
Credit Card Number:
Expiration Date:
Phone Number:      Fax Number:
Card Holder Signature:

Date: //
Statement Billing Address:
(office use)
Authorization Number:
 

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