Preferred Buyer Credit Card & Delivery Authorization Customer's Name * First Name Last Name Company's Name * Phone * (###) ### #### Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Card Type * Visa MasterCard American Express Discover Credit Card #: * Exp Date: * CVC: * List up to 7 persons authorized to make purchases and arrange receipt of material for your company: * Upon completion of this form, I acknowledge that I need to send a picture of the front & back of the credit card used, and a picture of a valid driver's license to documents@gwmurphy.com to authenticate my identity. * I understand E-Signature * First Name Last Name Date * MM DD YYYY As a Preferred Buyer of materials from Murphy's Roofing Supply, I hereby authorize Murphy's Roofing Supply, Inc to retain my credit card information for us on current and future purchases. My signature authorizes Murphy's Roofing Supply to make deliveries of material in my absence to the authorized materials receivers listed above. I also, indicate understanding and acceptance of all terms, conditions, and personal guarantees described on Invoices, Sales Order Acknowledgments and/or Credit Applications. * I acknowledge this Thank you!
