Credit cards purchases can only be made if the purchaser has a card in his/her name, or the Credit Card Authorization Form has been filled out and returned to us.

Fax number is (440) 775-8573, voice line is (440) 775-8628.

The form must be filled out completely!

Cardholder Name (Please print or type): ______________________________________________

Billing Address of Cardholder: _________________________________________________

City: ________________________ State/Province: _____________

Zip Code: ________________ Country:_________________________

IMPORTANT: Turn the card over. In the signature box there should be an electronic reprint of part of your account number with additional 3 digits. The last 3 digits are the CVV2 code. Write the CVV2 code here: ___________

Cardholder Account number (16 digits): _____________________________________

Expiration Date: __________

Circle card type: Mastercard    Visa    Discover

Maximum amount to be charged (with 6.25% OH sales tax ): ___________________

Work Phone: (_____) ______________________

Home Phone: (_____) _____________________

I AGREE TO PAY THE ABOVE TOTAL AMOUNT ACCORDING TO THE CARD ISSUER AGREEMENT.

Cardholder signature:_____________________________________________________

Student name (Please print):_______________________________________

Student ID Number (9 digits): ________________________________

PLEASE COPY BOTH SIDES OF YOUR SIGNED CREDIT CARD ONTO THIS SHEET BELOW, AND FAX TO OBERLIN TECHNOLOGY STORE at (440) 775-8573.