Company Information
Contact Name:
Company Name:
Street Address:
City/State/ZIP:
Phone:
Email:
Credit Card Information
Card Type:   ☐ MasterCard        ☐ VISA        ☐ Discover        ☐ AMEX             ☐ Other __________________________________
Cardholder Name (as shown on card) :
Card Number:
Expiration Date (MM/YY):
CVC:
Billing Information
Street Address:
City:
State:
ZIP:
Customer Signature:
Date:
I, ___________________________________________ , authorize The Sunshine Lighter Co. to charge my credit card
above for agreed upon purchases. I understand that my information will be saved to file for future
transactions on my account.
Credit Card Authorization Form
The Sunshine Lighter Co.
730 Glades Ct, Port Orange, FL 32127
Phone: (386) 322-1300   Fax: (386) 788-0609
Email: sales@sunshinewholesale.com
Please print this page, complete all fields & return to us.
You may cancel this authorization at any time by contacting us.
This authorization will remain in effect until cancelled.