CREDIT CARD FAX FORM


Print this page and FAX TO: 818-897-1947


Your Name:
Phone Number:
Email Address:
Your Account #:
Order Date:
Credit Card Number:
By my signature below, I authorize Franklin Truck Parts, Inc. to charge items ordered on this date to my
(Please circle one.)
Visa ---- Mastercard ---- Discover ---- American Express


Signature: