California:
1505 N. State College Blvd. Anaheim, CA. 92806
Ph: 714.776.5555 . Fax: 714.776.5556
» info@salvageantiques.com
New Jersey:
246 Beacon Avenue, Jersey City NJ 07306 USA
ph: 201.222.6367 - fax: 201.222.6368
» info@amighini.net

 » CREDIT CARD FORM

» CLOSE  


If you wish to pay by Credit card, please download this form. Fill it out, sign it and send it back to us by fax at CA: 714-776-5556 * New Jersey: 201-222-6368.

Please complete your billing and shipping information to process your order.

Item #:  

Customer and Billing Information (where you recieve your CC statement)

First name: Last name:
Address :
City: State:
Country: Zip code:
Phone: E-mail:
Would you like to get a shipping quote? Y    N .

Credit Card Information
-Check your credit card

  MasterCard       Visa
Name as appear on the card:
Card Number:
Expiration date:
Verification Code Number:

Shipping information
-Check if same above:

First name: Last name:
Address :
City: State:
Country: Zip code:

I agree to purchase this/ese item/s and authorization to Amighini Architectural Inc
to charge on my credit card the amount of $    (American Dollars).
I understand that all work is custom made and no refunds apply.


Customer signature:.................................................................    Date:  


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