This document authorizes INFOTECH USA, INC., or its affiliate to charge your credit card for payment

Cash Type: Visa Master Card American Express Discover
 Credit card number: Expiration date: /
Card verification number (3 digits code for MC/Visa/Discover and 4 digits for American Express):
 Card holder’s name (exactly as it appears on card):
Name of credit card issuing bank: Tax Exempt # (if Applicable):
Purchase Order # :  E-mail Address :
 Billing Address (As appeared in credit card statement): Please check this box, if billing &shipping address are same
 Name: Shipping Address (If different then billing)
 Company Name: Name:
 Address 1: Company Name:
 Address 2: Address 1:
 City/State/Zip: Address 2:
 Phone #: City/State/Zip:
 Fax #: Phone #:
Qty ISBN (Book #) Name of Title & Author Each Price Amount
    Sub Total :
  (New York residents, please add 8.65% Sales Tax) Sales Tax :
                       Shipping Charges:(Add $5.95 for first book and $0.95 for each additional book) Shipping :
    Total charge to credit card :

Please enclose a list of books, if you have order for 6 or more titles

I agree to pay the above charges according to the card issuer’s agreement. I understand that my signature on this contract will serve as my authorization on the credit charge slip and as a signature on file for all authorized charges and outstanding balances now and in the future. As registered user of this credit card, I authorize INFOTECH USA, Inc., to ship this order to address requested on my order, and I am responsible for any person receiving this order, if selected the different address then billing address. I UNDERSTAND THAT USING A CREDIT CARD FRAUDULENTLY IS ILLEGAL AND CHARGES WILL BE PURSUED TO THE FULL EXTENT OF THE LAW.

Cardholder’s signature: ____________________________________ Today’s Date: ____________________________
Please fill in all the fields, print, sign, date and fax to 516-568-0566
If your shipping address is in New York state and you are tax exempt, please fax a copy of tax exempt certificate
with this form.