Credit Card Authorization Form

    USAUSAIMPORT
    5955 Belmark St.
    Houston, TX 77033
    713-584-584-0587

    Credit Card Authorization Form

    Please complete all fields.

    Card Type: Master CardVISADiscoverAMEXOther
    Cardholder Name (as shown on card):
    Card Number:
    Expiration Date (mm/yy):
    Cardholder ZIP Code (from credit card billing address):

    I, , authorize to charge my credit card above for agreed upon purchases.

    Customer Signature Date