Lue-Lue's World - Caring for your pet is in our nature!
 
Lue-Lue's           CREDIT CARD AUTHORIZATION FORM                   Date_______________
 
I __________________ Authorize ___________________ to charge my credit card
           (NAME)                                            (COMPANY)                         
 
For services rendered. Not to exceed the amount shown.      
 
AMOUNT                       $_________________USD.              
 
CREDIT CARD TYPE      ____________________
 
CREDIT CARD #             ____________________
 
CARD CV2 #                    ____________________
 
ISSUED DATE                  ____________________
 
EXPIRATION DATE       ____________________
 
BILLING ADDRESS        ____________________
                                       
                                          ____________________
 
BILLING ZIP CODE        ____________________
 
NAME ON CARD            ___________________________________________
                                                            (As it appears on card)
 
SIGNATURE_______________________________ DATE __________________    
 
MAIL TO:
Lue-Lue's
5412 N Lovers Lane Rd
Milwuakee, WI 53225

DO NOT WRITE BELOW. COMPANY USE ONLY.   
 
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