Saturday, February 04, 2012
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OX-USA

440 S. PINELLAS AVE.

TARPON SPRINGS, FL  34689

OX-USA LAYAWAY PROGRAM AUTHORIZATION

Name  
Billing Address  
Email Address  
Phone Number  
Product Part Numbers  
Description of Product  
Quantity of Each Product  
Monthly Payment Amount  
Credit Card Information  
Card Type  
Card Number  
Expiration Date  
CV Code  
Additional Request  
By pressing the send button I authorize OX-USA,Inc to charge the above reference credit card the selected sum each month until the total amount described is paid. When the sum of payments has reduced the total balance to less than the selected amount, the final credit card charge will be the final actual amount due.  
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Layaway Program
 
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