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GOLD LASER ACADEMY 75 Jackson Avenue Cosset, NY 11791 Telephone: (516) 498-2804 Fax: (516) 498-2811 CREDIT CARD & CARDHOLDER INFORMATION NAME AS IT APPEARS EXACTLY ON CARD BILLING ADDRESS CITY STATE

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Credit card refers to a payment card issued to users (cardholders) as a method of payment. A cardholder is the individual or entity to whom the credit card is issued.

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Any individual or entity that holds a credit card or acts as a cardholder is required to file information related to credit card transactions.

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Information such as transaction dates, amounts, merchant names, and any other relevant details of credit card transactions must be reported.

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