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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