Building Systems Solutions

Paper or Plastic?

Pay with a Credit Card!                                 

While CCSI offers standard net payment terms with approved credit, instead of generating piles of paper bills each month, why not use plastic? Just use a MasterCard, Visa, American Express or Discover card for CCSI products and services. You'll gain productivity and save money! Fill out the Credit Card Form below and fax upon completion to our office at (205) 951-1444. As an option, CCSI can provide you with credit terms based upon your credit application being submitted and approved by our Accounting Department. Fill out the Credit Application form and submit it electronically or fax it to our office.

NOTE: For security purposes, when submitting credit card information leave the card number box blank. Please contact our office and provide the card number to one of our support staff members in our Credit Dept. 

		Business/Customer Name *		Name on Credit Card *

		Street Address *

		City *		State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming		Zip Code *

		E-mail Address		Contact Phone *		Contact By E-mail Phone

		Invoice Number *		Payment Amount *

		Credit Card Type * Visa Mastercard American Express Discover		Credit Card Number *		Expiration Month * Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec		Expiration Year * 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

		Comments or Requests:

* Required to submit this form