Credit Card Authorization for:
WHEELS AUTO RECYCLERS. LTD
1021 W. FM 6
Nevada,Tx 75173
Tel.-972-843-2667        
 Fax-972-853-0600
Purchase authorization to use credit card

Date:____________        Card Holder Name:____________________


Billing address:______________________        Home Phone # _____________________
                    ________________________            Work Phone #_________________
                       ______________________                         Fax#_____________________
Credit card #________________________________   Expiration date___________   CVVC#______


Type of Credit Card        
   Visa             Mastercard               American express          Discover      other
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Ship to :   __________________               contact:___________________
                             
 address:  __________________    City:_________   State:___________                                           

                                                                                                                                                                                                                   
Year________ Make__________ Model________      Part type __________________
Description:_______________________________  V.I.N._______________________________
LH_____  RH_____   Notes______________________________________________________
___________________________________________________________________________________

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I hereby authorize Wheels Auto Recyclers to charge the order described above on credit card as noted
above. I understand that this order is placed via telephone and my signature on this agreement is binding.
This purchase is for used parts , I understand that if for any reason i refuse this shipment the freight
charges will be charged to my credit card. These parts carry a 90 day warranty unless noted in writing

Part price$_________     Freight quoted$________________     Total Price to be billed  $_____________

Card holder signature:___________________________