STARK Credit Card Authorization Form
STARK Credit Card Authorization Form
ieFient efi,c761") , hereby authorize Stark Carpet Corp. to charge my card
for the amount indicated below. i understand these charges are for the payment of goods and/or
services by the above referenced merchant.
Account #:
Invoice/Order #: clzio.3oci
Amount to be charged: m/OOO
Credit Card Type:
Credit Card #: Amex Et/
Credit Card Expiration Date:
CVV /Security Code: Visa 0 MasterCard 0
Company Name:
Cardholder Name: ,/ec,chAez. Y C-70 S7-61A,
Billing Address: cec-roi s
City: ,A) at-0 (o At A/ State:
Phone #: NV Zip Code: (002/
Email address for CC receipt:
Terms & Conditions: The above named client understands and acknowledges the charges described above. The
client agrees payment in full is to be made when billed in accordance with the standard policy of the issuing bank
and without any disputes or stop payments on the above credit card.
Please sign below agreeing to the above ter d conditions:
Cardholder Signature:
Print Name: 1&filrfr 6C ic~ Date: ioA cite
EFTA00520879
STARK D B D Dote: 10/05/2018
979 THIRD AVENUE. NEW YORK. NY 10022 Quote #: 240308
(2)2p52-9000 Account t$: 45284
Bill To: Ship To: RE:
JSC INTERIORS
575 LEXINGTON AVE Shuliak Residence
9 East 71 Street PROJECT: Shuliak Library
PO It:
NEW YORK NY, 10022 NEW YORK NY. 10021 JOB ft: ESTIMATE
AREA(S): LIVING ROOM
To deliver and install wall to wall carpet over 40 ox synthetic padding using lackkss method. Seaming is required. price includes rip up and
disposal.
ASTINN - WHITE
REPEAT: W: 3/e X L:111/2"
CONTENT: 100% WOOL
CONSTRUCT: WILTON
PILE: LOOP PILE
ORIGIN: SPAIN
WIDTH: 13' 2"
To proceed with your order. please return a signed copy of this quote along with
your 50% deposit.
If you have any questions, please email me atmillinimm
Thank you.
TENZING NEPALI DESIGNER NET: $23400.00
SALES TAX (NY - 8.875%): 52.118.91
FREIGHT: $375.00
TOTAL PRICE: 525.993.91
ACCEPTED DATE: / lb
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EFTA00520880