If you would like to pay for a purchase order, please provide the appropriate payment information below. You should have been provided with a Prepayment Quote number.
A confirmation email will be sent to this address. We do not use your email address for marketing purposes.
I authorize the above business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods described above; or attached for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with the credit card company; so long as the transaction corresponds to the terms indicated in this form. This transaction will appear as Premium Incentive Sales on your merchant statement.
© 2018 Premco Associates
9889 E. Easter Ave.
Centennial, CO 80112