2024 R.R. LALENA BUYER'S GUIDE

CREDI T CARD AUTHOR IZAT I ON FOR CUSTOMER R.R. LALENA CORPORATION 59-26 55th DRIVE, MASPETH, NY 11378 USA TEL: 718.326.9788 | FAX: 718.326.8765 | TOLL FREE: 1.800.R.LALENA | WEBSITE: RRLALENA.com I, _________________________________ hereby authorize R.R. LALENA CORP. to charge my credit card. (print your full name) TYPE OF CREDIT CARD :  VISA  MASTER CARD  AMEX  DISCOVER ACCOUNT NUMBER: _____________________________________________________________________ VALIDATION CODE: ____________ (must be filled) CARD EXPIRATION DATE: _________________ CARD HOLDER’S NAME: __________________________________________________________________ CARD ADDRESS: ________________________________________________________________________ CITY: ___________________________ STATE: __________________ ZIP CODE: _____________________ TEL: ___________________________ EXT: ____________ BUSINESS NAME: _______________________________________________________________________ BUSINESS ADDRESS: ____________________________________________________________________ CITY: ___________________________ STATE: __________________ ZIP CODE: _____________________ NOTES: IF YOUR CHECK BOUNCES, WE WILL CHARGE YOUR CREDIT CARD AN ADDITIONAL $40 FEE ON TOP OF THE TOTAL ORDER AMOUNT. FOR PAYMENTS BY CREDIT CARD IT WILL BE APPLIED CONVENIENCE FEE (3% OF TOTAL AMOUNT). PRINT YOUR FULL NAME: ________________________________________________________________ SIGNATURE: ____________________________________  KEEP ON FILE FOR TAKING CARE OF FUTURE PAYMENTS PRINT YOUR FULL NAME: ________________________________________________________________ SIGNATURE: ____________________________________ DATE: ____/_____/_____ PLEASE, FAX BACK THE FORM WITH A VALID COPY OF YOUR DRIVER’S LICENSE AND BACK & FRONT OF THE CREDIT CARD.