New Horizon Buildings and Concrete

336-799-1106 or 336-335-9519

4047 US Hwy 311

Randleman, NC 27317

Credit Card Authorization Form
Please complete all field below before returning.

Credit Card Information
Card Type:
Cardholder Name(as shown on card):
Card Number:
Expiration Date(mm/yy):
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Authorize New Horizon Buildings and Concrete to charge my credit/debit card
above for agreed upon amount. This payment authorization is for one time use only. I certify that I am an authorized user of this credit/debit card and I will not dispute the payment with my credit/debit card as long as the transaction corresponds to the term indicated in this form.
Customer Signature