• Mon-Fri, 9am-5pm (PST)
  • 21541 Nordhoff St Unit C, Chatsworth, CA 91311
  • 1-818-609-9299

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I hereby authorize Audionics System, Inc. to keep my Credit Card on file to process against Purchase Orders that I may place with Crux Interfacing Solutions.
Type of credit card: (required) VISAAMEXMASTER CARDDISCOVER
Credit Card Number:
Expiration Date (Month/Year):
CVV Security Code:
Customer (Store) Name:
Card Holder Name(Exactly as it appears on card)
Billing Address:
City:
State:
ZIP Code:
Shipping Address:
City:
State:
ZIP Code:
Phone:
Your Email (required)
Fax:
Federal Tax ID #:
A COPY OF THE RESELLER PERMIT IS REQUIRED. PLEASE FAX IT TOGETHER.

WHEN/IF YOUR CREDIT CARD IS EXPIRED OR YOU HAVE A NEW CREDIT CARD; YOU MUST CONTACT US TO KEEP THE RECORD CURRENT.

PLEASE FAX THE COMPLETED FORM.
Fax Number: 818-996-8188