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Ingram Micro

THE ENG GROUP LLC

Business Development Group

Credit Card Authorization

18851 NE 29TH AVE, SUITE 700, AVENTUIRA, FL 33180

Phone Line 954-323.2024
| 778.8543

Fax line: 305-393.8111

E-mail: [email-masked]

The following is an authorization, by the cardholder listed
below to charge said credit card, for the

dollar amount of the invoices listed below:

CUSTOMER NAME:

THE ENG GROUP ACC. NUMBER

Card Type

Mastercard (      )

Visa (      )

Discover (      )

Card Number #

Issuing Bank

Expiration Date:

Card Holder Name:

Billing Address:

City, State, Zip
Code:

Phone # :

Secure ID:

(the three digits
on the back)

Cardholder
Signature:

Invoice #:

Invoice Amount:

Please include a copy of identification and front and back of
the creditcard

Por favor, incluir una copia de la tarjeta de ambos lados y de
una identificación