Credit Card Payment Authorization

FIll out the form below and we will contact you as soon as possible.

Credit Card Info:

Card Type:

VISA MASTERCARD AMERICAN EXPRESS

Credit Card Number:

Expiration Date:

Name on Card:

Security Code:

I hearby authorize Myton Industries, Inc. to charge the above credit card account for the amount of:

Authorized Credit Card Signature:

Name:

Company Name:

Billing Address:

Company Name

Contact Name

Contact Email

Contact Phone

Billing Address

City

State

Zip

Shipping Address (If Different):

Company Name

Contact Name

Contact Email

Contact Phone

Shipping Address

Shipping Address 2

City

State

Zip

Invoice Totals

Sub Total

Shipping Total

Invoice Total

Credit Card Processing Disclaimer

Payment Authorization and Terms

By providing your credit card information and submitting this form, you acknowledge and agree to the following:

Payment Processing: Your credit card information will be securely transmitted to our third-party payment processor for transaction processing. We do not store your complete credit card information on our servers.

Authorization: You authorize us to charge the specified amount to your credit card for the services/products indicated. If you are acting on behalf of a business or organization, you confirm that you have the authority to make this payment commitment on behalf of that entity.

Billing Agreement: You agree to pay all charges associated with your purchase when due. In the event of non-payment or chargebacks, additional fees may apply as permitted by law and our terms of service.

Liability: Both you personally and any business entity you represent agree to be liable for all authorized charges made through this payment form.

Authorized Signatory: If you are submitting payment on behalf of a business, you certify that you are an authorized officer, partner, or owner with the legal authority to make this payment commitment.

🔒 Security Notice

Your payment information is protected using industry-standard SSL encryption. We are committed to protecting your financial information and comply with PCI DSS security standards.