CREDIT CARD AUTHORIZATION FORM

I authorize CardService International to charge my credit card for the amount of $295.00. I understand this is a final non-disputable transaction.

X______________________________________ Signature

_______________________________________ Printed Name

_______________________________________ Credit Card Number

                                           ________/________   Expiration Date

Mailing Information:
Please mail or fax* this authorization slip, the agreement and a voided check to:

TeleCharge Texas - 019
450 N. Sam Houston Park Way, Suite 273
Houston, TX  77060
Attention: TeleCharge Agent Service  Chuck Taylor, Sr. Account Rep.
Fax:  281-445-7257
*The original copy must follow all faxed information.

Chuck Taylor Sr. Account Executive Cardservice-Texas

450 N. Sam Houston Parkway   Suite 273 Houston, TX  77060 Phone:  281-445-6941 Fax:  281-445-7257

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CardService International is the Nations Largest & Fastest Growing Online Merchant Services Provider. For the Most Current and Complete Answers to all Your E-Commerce Questions and Needs.

Call: Chuck Taylor 800-948-6457 ext.18
Cardservice International is a registered Agent for the following FDIC Insured banks: First National Bank of Central Florida, Longwood, FL, Humboldt Bank, Eureka, CA, Redding Bank of Commerce, Redding, CA, Tehama Bank, Red Bluff, CA, Bank of Oakland, Oakland,CA