When taking credit card information from your customers, it's important to get the right information.  Missing information makes it impossible for the charge to be processed.  But it is even more important that the customer's sensitive information is protected.  

The bottom two copies will not show the first 12 digits of the credit card number, only the last four.  This allows you to give a copy to your customer, and keep one for yourself, which enables the top copy to be destroyed once processed. 

You will still have a record of the charge (and customer signature) while ensuring the customer's card number is not saved anywhere.