EFTA02311056.pdf

"have authorized Porcelanosa New Jersey, Inc. to charge the amount to the card set forth above"

"Billing Address:9 --sh lUl City. ay.) & rY. State: N Zip Code: 10O2"

"to charge my credit card set forth below the amount of $ USD."

"Sign the form and FAX it back to 917-289-1228. Attn: Marisa Bordonaro"

"600 ROUTE 17 NORTH. RAMSEY. NEW JERSEY 07446"