SUPRAMEDICAL CREDIT CARD AUTHORIZATION FORM

    (last three digits on back of credit card for Visa, MasterCard, and Discover. For American Express four digits on front of card)

    Card Type

     

    Billing Information

    I authorize SUPRAMEDICAL LLC. to charge my credit card as stated above. And accept this sale on the explained conditions, the sale is final and there are no refunds in the product I’m purchasing.

     

     

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