Credit Card Authorization

Credit Card Authorization

For credit card authorization, please complete and submit the form below.

BILLING INFORMATION

CARD INFORMATION

ORDER INFORMATION

FINAL APPROVAL

I authorize Reuther Material Company to charge my Credit Card for materials purchased and/or services performed. I also agree to indemnify and hold harmless Reuther Material Company for all charge backs that could occur from this transaction, should this charge not be honored by the Credit Card Company/Bank. I further agree to reimburse Reuther Material Company for any legal action and or collection costs that could be incurred as a result of a charge back or any other rejection of payment from the Credit Card Company/Bank in regards to this transaction. Card information retained for repeated use will be held until written notification is received to discontinue use thereof.

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