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TLC CALIBRATIONS COMPANY

CREDIT CARD AUTHORIZATION FORM

Credit Card Authorization

BILLING INFORMATION

SHIPPING INFORMATION

PAYMENT INFORMATION

ADDITIONAL INFORMATION

Note: Credit Card Payment will include 3% surcharge, 5% for AMEX
By signing this form, you authorize Technical Life Care Medical Company to charge your credit card for the amount listed above (plus the credit card surcharge, if not listed in the total).


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