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Tuesday, June 18, 2013
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Layaway Program
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OX-USA
440 S. PINELLAS AVE.
TARPON SPRINGS, FL 34689
OX-USA LAYAWAY PROGRAM AUTHORIZATION
Layaway
OX Offroad Products
Name
Billing Address
Email Address
Phone Number
Product Part Numbers
Description of Product
Quantity of Each Product
Monthly Payment Amount
$25.00
$50.00
$75.00
$100.00
$125.00
$150.00
$175.00
$200.00
Credit Card Information
Card Type
Visa
Mastercard
Discover
American Express
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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