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Archbald, PA
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Good Spring, PA

Stavola Credit Card Authorization

Date

Location

Company Name

Contact Name

Contact Phone

Card Type

Credit Card Number

Expiration

CVV Code

Comments

I authorize the above Stavola Company to process the credit card above. I understand Stavola does not retain any credit card information and this form must be printed and faxed/emailed to the appropriate site and that credit card authorizations are only valid for a single day.

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