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MERRICK TACKLE
Order Toll Free: 800-628-8904 / 24/7 Toll Free Fax 800-686-7763
POLICY PAGES
Merrick Tackle Center, Inc.
SIMPLIFIED ACCOUNT FORM
(For Credit Card or Cash COD Only)
Part I
Please complete the following and return by mail, fax or email. You may submit your order along with this application.
Date: _________________________
Applicant Name:
_______________________________________ Title: _________________________
Business Name:
_____________________________________________________________________
Billing Address:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Shipping Address:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Email:
____________________________________
Website:
_________________________________
Phone:
____________________________________
Cell:
_____________________________________
Fax:
______________________________________
Check one:
I wish to pay by Credit Card. (Please fill out part II)
I wish to pay by Cash COD
Part II
Charge Card
Signature of card holder is held on file as authorization.
Check one:
VISA MASTERCARD AMERICAN EXPRESS DISCOVER
Card No:
______________________________________
Exp. Date:
___________
CID#
____________
Name as shown on card (Please print):
__________________________________________________
Signature of card holder:
______________________________________________________________
Signature gives Merrick Tackle authorization to charge my current card for any invoices not paid within account terms.
Billing Address:
_____________________________________________________________________
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