COD Account Application "*" indicates required fields Date* Month Day Year Company/Individual name* Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email address* Owner* Owner signature*I (We) hereby authorize Jordan’s Building Center Inc. to store my (our) credit/debit card ending in (last 4 digits). I further authorize Jordan’s Building Center Inc. to make repeated and/or unscheduled charges to my(our) credit/debit card for future purchases that I verbally or otherwise authorize from time to time and, if necessary, initiate adjustments for any transaction errors. This authorization will remain in effect until Jordan’s Building Center Inc. is notified by me to cancel this authorization. I further understand and agree to abide by Jordan’s Building Center Inc.’s refund policy related to this and any other purchases made with my credit/debit card on file. Any future changes made to this agreement will be send via email at the address above.Credit card on file?* Yes No If “No”, you will be given a Credit Card Authorization form to download, fill out and upload for our records.Download Credit Card Authorization form Download nowUpload Credit Card Authorization formAccepted file types: pdf, doc, docx, pages, jpg, gif, png, Max. file size: 20 MB.Other notesCAPTCHA
