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Boomerang Credit Card Authorization Form
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Bill To Address:
First Name
Last Name
Company Name
Address 1
Address 2
City
State
Zip
Phone
Email Address
Credit Card
Visa
Discover
American Express
Master Card
Card Number
Expiration
Pick-up Location: (if different than above)
Address 1
City
State
Zip
Initials Authorizing Boomerang to charge the above credit card for laundry and dry cleaning services rendered