Superior Safety Codes Secure Site
Credit Card Authorization
Authorization for credit card use form
Name of Customer / Company
Name of Contact
Address
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Email Address
Contact Phone
Payment information
Credit Card Type
Visa
Mastercard
Name of Card Holder
Credit Card Number
-
Terms & Conditions
Your authorization
I authorize Superior Safety Codes Inc to keep my information on file to process payment of current and any future transactions
I have read & I agree
I hereby knowingly and irrevocably authorize Superior Safety Codes Inc. to charge purchases made from Superior Safety Codes Inc. to the above credit card. The credit card account information provided herein shall be used only for the intended purpose as authorized. Cardholder shall indemnify and hold Superior Safety Codes Inc. harmless from all loss, damages, expense or liability in connection with authorized use of the above said credit card. Any use by Superior Safety Codes Inc. is limited to the purchase of permits or inspection services to the Cardholder. All information disclosed herein is true and correct, without exception. In the event the information disclosed in the credit card authorization form is in any way incorrect, false or fraudulent, the cardholder shall be liable for all costs, expenses and attorney fees incurred in protecting Superior Safety Codes Inc. rights and interests. Superior Safety Codes Inc. shall not be liable to the cardholder for any incidental, consequential, special or punitive damages arising out of this authorization. By filling in the form above I acknowledge terms of Superior Safety Codes Inc. and agree to abide by rules and policies of same. I hereby agree to pay all charges incurred by me until the cancellation of my account. Superior Safety Codes Inc. reserves the right to refuse or cancel service to anyone and change restrictions without notice.
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