EmailMe Form - Copy of Reeves APPLICATION FOR CREDIT CARD

Secure Form

NOTE: All applicable information must be filled out completely to ensure timely processing of the application.

CARDHOLDER NAME *

First Last

Billing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Fax

### - ### - ####

Email *

SEND INVOICES & STATEMENTS VIA EMAIL: *

YES

NO

BOTH

AUTHORIZED USERS (other than cardholder):

ATTACH ACE REWARDS: *

Yes

No

Not an Ace Rewards member, but would like to join

ACE REWARDS CUSTOMER NO:

SALESMAN:

SPECIAL INSTRUCTIONS:

This serves as authorization for Reeves Hardware Company to debit my Credit Card Number: *

Enter Credit Card Number

Expiration Month/Year: *

MM / YY

I understand that transactions for merchandise will be charged to my credit card at the time of purchase. Only the last four digits of the card number are visible to cashiers. These transactions may be made by and will be signed by authorized users only.

CARDHOLDER SIGNATURE *

Clear

*This information will be held strictly confidential and will not be copied or shared for use at other businesses, even by authorized users.