Lou Negley Payment Sheet

Water Softener Salts

I authorize Lou Negley’s Bottled Water, Inc. to keep my signature on file and to charge

my credit card account the total amount due for each order placed.

This authorizes Lou Negley’s Bottled Water, Inc. to charge the above listed credit card

for all monies (product and shipping & handling) due. This authorization will remail in effect until revoked by the cardholder in writing or by other notice acceptable to Lou

Negley’s Bottled Water, Inc.

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