979 Third Avenue,

Suite 1800
New York, NY 10022

Tel: 212-593-2060
Fax: 212-832-3687

John Rosselli & Associates Ltd.

CREDIT CARD AUTHORIZATION
FOR ALL ORDERS
April 10, 2024
DATE: _____________

C. Cary Brown
SALES ASSOCIATES: _______________________________________________________

Robert Coutorier inc.

COMPANY NAME: ________________________________________________________

Sally Ann Calabrese

CARD HOLDER NAME: _____________________________________________________

4246 3153 7831 7356

AMEX/MASTERCARD/VISA ACCOUNT #______________________________________
(Please Circle One)

05/28
EXP. DATE: __________________ 052
SECURITY CODE: ____________________

271 Madison Ave, Suite:1108 New York, New York

BILLING ADDRESS: _______________________________________________________

10016
BILLING ZIP CODE: ________________________________________________________

$66
AUTHORIZED AMOUNT TO CHARGE: _______________________________________

178189
INVOICE NUMBER: _________________________________________________________

Claire Lee
I _____________________________, authorize John Rosselli & Associates to charge my credit card for
the amount indicated

NOTE: There will be a 4% Non-Refundable Processing Fee on All Credit Card Payments.
When paying by Credit Card, We Require Full Payments for all FABRIC/WALLPAPER Orders.
50% Deposit on Furniture orders can be paid by Credit Card. Final Balances can be paid by Credit Card
or by Check.
NO RETURNS / CANCELLATIONS FOR FABRIC, LEATHER, OR WALLCOVERING.
NO RETURNS / CANCELLATIONS ON LIGHTING & FURNITURE ORDERS.

SIGNATURE OF CARD HOLDER

Sally Ann Calabrese
_________________________________