Dear: 

L'Arredobagno di Caselli Giorgio & C . S.n.c.

C.so Garibaldi,10/b - 48018 FAENZA    RA    ITALY

Tel. 0039 0546 22372     Fax 0039 0546 688266

SUBJECT: Authorization to debit with Credit Card

The undersigned ___________________________________________

date of birth___________ resident in __________________________

address ____________________________Country________________

The owner of the:

Credit Card (Visa, MasterCard or American Express)_______________

Number Credit Card _____________________________CVV2(_ _ _)__

Expiration Credit Card _______________________________________

I authorize you to debit the import of:

€uro:___________________

throught of the Credit Card with the data on indicated, like payment of the material agreed in the contract of sale (order confirmation, proforma invoice or invoice)

number_________ in date______________

Signature

For your total safety to send back this document compiled only via fax to the number 0039 (0)546 688266.

Privacy
We inform you that the personal data that you supply may be processed in compliance with italian law decree 196/2003 concerning the protection of persons and other subjects with regard to the processing of personal data.
The personal data will be processed with the utmost confidentiality and will be used for the execution of the contract, of the transaction and for the processing of the purchase order for the products. The supplying of personal data is obligatory for the purpose of the provision of the service.
The owner of the data for the execution of the contract is L'Arredobagno di Caselli Giorgio & C. S.n.c. - Corso Garibaldi,10/b - 48018 - Faenza (Ra) - Italy

No other processing will be performed without your express consent.