You're welcome too send us your credit card information via fax or phone if you'd rather not disclose it online. Just print this form, fill it out and fax it to us at: +1 (412) 683-6415.
If you have any questions, or would prefer to give us this information on the phone, you can call us at +1 (412) 683-6210.
Name _____________________________________________________ Street ___________________________________________________ City, State ______________________________________________ Zip/Postal Code, Country _________________________________ Email address_____________________________________________ Home Phone________________________________________________ Work Phone________________________________________________ Type of Credit Card: __ Visa __ MasterCard __ American Express _______________________ _ _ - _ _ Account Number Exp. Date Name as it appears on the card: _________________________________________________________ I agree to abide by the terms of my card issuer agreement: _________________________________________________________ Signature