Lancaster House, 17 Dundonald Street, Suite 200, Toronto, Ontario, M4Y 1K3
Phone 416-977-6618 or 1-888-298-8841 / Fax 416-977-5873
E-mail customerservice@lancasterhouse.com

Credit Card Authorization Form
Books/Newsletters/Services

Please print this form and fax it to Lancaster House at 416-977-5873.
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REGISTRANT NAME:


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CARD NUMBER:


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EXPIRY DATE:


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NAME OF CARDHOLDER:


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