ASM Overseas Corporation Credit Card Charge Authorization Form

1108 W. Valley Blvd., Suite 6392 , Alhambra, CA 91803,USA
Tel: 626-458-8009, Fax: 626-458-8434
E-Mail: , Internet: http://www.cbw.com

Please fill and print out the form, have it signed by the CARD HOLDER   and fax it back to us.  Please note ASM Overseas Corporation will appear as the company charging you on your credit card statement.

Date:

Invoice/File Number:

Product/Service Description:

Charge Amount:

Card Holder's Name (First Name, Middle Initial, Last Name):

Phone:

Fax:

E-mail:

Credit Card Type:

Visa Master Card American Express (no other cards accepted at present)

Credit Card Number:

Expiration Date (MM/YY):

Billing Address:

State: Zip Code: Country:

Print out

CARDHOLDER'S Signature:

 

I thereby authorized ASM Overseas Corporation to deduct the stated amount from my credit card.
FOR REFUND: A Cancellation Charge $15 USD plus 4% of Banking Service (by banks involved in processing) will be calculated and deduct from refund amount.