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Business Name: .
Current Address:
City: ................. .
State: ............... .
ZiP : ................. .
Name as it appears on card:
Credit Card Number: ........ ..
Card Verification Number:.. .
Last three numbers in back of your card
Credit Card Type:.............. .. Visa or MasterCard
Expiration Date: ...................
Credit Card Billing Address: .
Billing City:....................... ....
Billing State:..................... ....
Zip:................................. ......
Please complete this order form and fax or email to us at:949-748-5208 or 800-517-1205 email info@citicredit.net
If you have any questions feel free to call us at
1-800-710-CITI(2484) 9AM-5PM(PST)