Blend Hospitality & Blend Home Furnishings Billing Address 1325 Frisbie Lane Cookeville TN 38501

Telephone: 800-590-8978 Fax: 800-886-0166

To  make  a  payment  via  credit  card,  please  complete  this  form  and  transmit  it  back  to  the  fax  or  email  below.  Please  include  a  photocopy  of  the  face  and  back  of  signed  credit  card.  

Fax:  800-­‐886-­‐0166  or  customerservice@blendhospitality.com  

CREDIT  CARD  AUTHORIZATION  FORM  

CREDIT  CARD  ACCOUNT  INFO  

I  hereby  authorize  Blend  Home  and  or  Blend  Hospitality  to  charge  the  above  credit  card  in  the  amount  of  $_________  

To  expedite  future  orders  and  payment  process,  I  hereby  authorize  Blend  Home  and  or  Blend  Hospitality  to    charge  the  above  credit  card  for  all  future  purchases  unless  otherwise  specified  verbally  or  wriVen  on    

official  purchase  order.          If  yes,  iniXal  ___________            If  no,  please  check:____________  

Your  compleXon  of  this  authorizaXon  form  helps  Blend  Home  and  or    Blend  Hospitality  protect  you,    our  valued  customer,  from  credit  card  fraud.    Blend  keeps  all  informaXon  entered  on  this  form  strictly  confidenXal.      

Please  contact  us  at  Blend  if  there  are  any  changes  to  the  above  informaXon