Astro Funding – Credit Card Authorization Astro Funding Strategy LLC Credit Card Form for Net 30 Accounts Please enable JavaScript in your browser to complete this form.Company or Personal Name *Address *City *State *AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code *Credit Card *VisaMastercardDiscoverAMEXCredit Card Number *Expiration *Security Code *Name as it appears on the card *Billing Address The Same *YesNoIf Card Billing Address If Different Than Address AboveBilling Address *Billing City *Billing State *AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingBilling Zip Code * This information will be used solely for the purpose of Establishing company credit for Company I Hereby Authorize Astro Funding Strategy to order products and services for the purpose of establishing credit for my company. Any products or services obtained will be donated to 501c3 when applicable. I further authorize Astro Funding Strategy to utilize the above credit card information for this purpose until revoked in writing. Company or Personal Name *Client Signature * Clear Signature Date *Submit
