Credit Card Authorization Form

Card Type*

Cardholder Name (as shown on card)*

Card Number*

Security Code*

Expiration Date (mm/yy)*

Cardholder ZIP Code*

(From credit card billing address)

Agreement…*

By checking this box, I authorize Twelve Pool Service, LLC to charge my credit card above for agreed upon purchases. I understand that my information will be saved on file for future transactions on my account.

Customer Name*

First Last

Customer Signature*

Use your mouse (computers) or finger (mobile touch devices).