Preferred Buyer Credit Card & Delivery Authorization Customer's Name * First Name Last Name Company's Name * Phone * (###) ### #### Email * Billing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Card Type * Visa MasterCard American Express Discover Credit Card #: * Exp Date: * CVC: * List up to 7 persons authorized to make purchases and arrange receipt of material for your company: * Upon completion of this form, I acknowledge that I need to send a picture of the front & back of the credit card used, and a picture of a valid driver's license to documents@gwmurphy.com to authenticate my identity. * I understand E-Signature * First Name Last Name Date * MM DD YYYY As a Preferred Buyer of materials from American Roofing Supply & Building Products, I hereby authorize American Roofing Supply & Building Products, Inc to retain my credit card information for us on current and future purchases. My signature authorizes American Roofing Supply & Building Products to make deliveries of material in my absence to the authorized materials receivers listed above. I also, indicate understanding and acceptance of all terms, conditions, and personal guarantees described on Invoices, Sales Order Acknowledgments and/or Credit Applications. * I acknowledge this Thank you!
