LibertyToner.com / Credit Card Authorization Agreement

Credit Card Authorization Agreement

Please print out this form, fill out completely, and email it to sales@alximaging.com


Card Holder Billing Information:
Name: Phone Number:
Address: City/State:
Suite/Rm/Floor: Postal Code:

Authorized Purchases for:
Company Name: Ship Attn:
Address: Phone Number:
Suite/Rm/Floor: Fax Number:
City/State/Zip: Email:

Credit Card Information:
[FrontPage Save Results Component]

Please select one:    Visa Visa          MasterCard MasterCard          Discover Discover          Discover AMEX

Credit Card Number: Expiration Date:
Name(s) on Credit Card: 3 Digit CVV Code:

Terms & Conditions of Sale: (Please read and understand before signing)

  • I, the undersigned,  agree to pay for all purchases according to the terms & conditions as they appear on the most current web site at ALX Imaging, LLC. I agree to pay all debts incurred within the terms of sale. No terms or conditions of purchase orders different from the terms of ALX Imaging, LLC will become part of the Sales Agreement.
  • The laws of the State of Texas shall be applicable to all suits arising under any agreement between the undersigned and ALX Imaging, LLC. In the event of litigation, venue shall be the choice of ALX Imaging, LLC. I/we further agree to pay reasonable collection costs and attorney's fees incurred by ALX Imaging, LLC to collect any outstanding balances.
  • I understand that, with my signature, I acknowledge that I have checked all information provided to ALX Imaging, LLC and it is correct, and that I have read, understand and agree to all the terms and conditions upon which this and all future purchases are governed.
  • I, the undersigned, give ALX Imaging, LLC permission to charge the full amount of all purchases, current & future, to the below mentioned Credit Card. Purchases included in this agreement will be in behalf of the company and/or individual designated within "Authorized Purchases for:", as well as the cardholder him/herself.

Cardholder Signature: Date:

Copyright © 2011/2013  ALX Imaging, LLC ~ 4080 Linne Road ~ Seguin, TX 78155
(210) 651-5000