VISA / MasterCard / Discover / Amex Authorization FormI understand and authorize Xanatek, Inc. to debit the amount of as per the quoted Price list (US) with cash discount, and that I will no longer receive a cash discount of 3% for the following product or service. Please enable JavaScript in your browser to complete this form.Company Name *Individual Name *Address *City *State *Zip *Billing Address Same address as aboveCity StateZipCredit or Debit Card *VisaMCAmerican ExpressDiscoverName as it appears on card *Card Number *CVV *Exp Date *Submit