Update your account or billing information by submitting this form via FAX or MAIL 24hrs a day / 365 days a year.

Steps: 1)
........ ...2) Fill out the form.
............3) FAX it or MAIL it to:  FAX:   1-562-286-8100  OR
................................. ...........  . MAIL:  RC Billing Dept.
...............................................   .......  .PO Box 1774
..................................................   ..  ...Norwalk CA, 90651-1774

(a) (Optional) Message: _____________________________________________________________________________________

    _____________________________________________________________________________________________________

(b)  Last 4 digits of your "Account Number" OR "Full Name" used when submitting your order: __  __  __  __  <<< (Last 4 digits)

......__  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  <<< (Full Name)

(c)  I would like to (please check one): [_] Update my card on file ending in x x x x - __  __  __  __ with the following.

............................................................[_] Replace my card on file ending in x x x x - __  __  __  __ with the following.

(d)  I would like to use the following card as a (please check one): [_] Primary-card...[_] Backup-card

(e)  I would like to use the following card (please check one):

…. .[_] Until my account is closed or further notice is given....[_] Only for the month of  _____________________ 2008.

(f)  The type of Card is (please check one):...[_] Visa...[_] MasterCard...[_] AMEX...[_] Discover

(g)  Full Name as it appears on card: __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __

(h)  Card #:  __  __  __  __   -  __  __  __  __  -   __  __  __  __   -   __  __  __  __

(i)  Expiration Date ( m m / y y y y ): __  __  -  __  __  __  __

(j)  Security Code (CVV #): ________ (This is the last 3 digit number on the signature panel located on the back of your card.
……………………...........................…...AMEX Cards have a 4 digit number located on the front of the card).

(k)  Daytime Phone #:...........1 ( __  __  __ )  __  __  __ -  __  __  __  __

......(Optional) 2nd Phone #: 1 ( __  __  __ )  __  __  __ -  __  __  __  __

(l)  E-mail Address: __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __

(m)  Billing Address: __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __ Apt #: __  __  __  __

.................................__  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __  __ State: __  __ Zip: __  __  __  __  __

(n) Authorized Signature: _________________________________________ Date: ______________
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