Naylor’s Custom Wind Repair Accessories Payment Form Fax 303-741-0129

FOR INTERNATIONAL ORDERS [incl. Canada]: Payment only by International Money Order in $US. [   ]  $US __________________ money order total for the accompanying Accessories Order. Please include this remittal advice and an international money order for the amount due. FOR U.S. ORDERS [incl. Alaska & Hawaii]: Payment available by check or by select credit cards in $US. [   ]  $_____________________ check total for the accompanying Accessories Order. Please include this remittal advice and a check for the amount due. [   ]  If you would like to pay by credit or debit card, I accept VISA or MasterCard drawn on a U.S. bank or credit union. Please complete the following authorization, and FAX or mail this stub to me. I authorize Naylor’s Custom Wind Repair to charge/debit my [   ] VISA [   ] MasterCard Account# _________________________ with Expiration Date _________ in the amount of $_________ for payment of the accompanying Accessories Order. ___________________________________ Printed name on credit card ___________________________________ Credit Card Signature Billing Address: Street _________________________________________ City, State, Zip code ____________________________________ Phone Number (_____) _____________________