Credit Card Authorization Form

Credit Card Authorization Form
United Roofing Supply

Dear Valued Customer,

Please confirm that the following information is accurate and you are a willing participant in United Roofing Supply® charging the following credit card. In addition, you acknowledge that no discount will be offered when paying via credit card.

If you agree with the above information,please sign below and fax back to:
We ask that a copy of your driver's license and the front and back of the credit card be included with the authorization form. Please be assured that this information will be kept in a secure file to ensure this information is kept confidential.