WEIMAN CARPENTRY SERVICES, INC.

Payment Form

CREDIT CARD PAYMENT Processing Form   Directions: Click on "Printer Friendly" button at bottom of form, print, complete, and mail or fax.

Full name as it appears on card:

Billing Address: _____________________                        _____________, MD _________ (zipcode)

Credit card type:  ___ Visa; ___ MC; ___ Discover

Credit card number: ______-______-______-______ Expiration date: _____ / ______

Card Identification Number (last 3 digits on back): ______

Amount Charged: $_________ (USD). 3% processing fee is charged to all credit card purchases/payments. This fee is added to the Amount Charged, and will be reflected in your receipt.

Signature: ________________________________

Fax or send the authorization to: Weiman Carpentry Services, Inc.; 661 Chapelgate Dr; Odenton, MD 21113 Phone: 443-306-9588; FAX: 410-674-8984