Credit Card Authorization Form

Customer Name: ___________________________________________

Address: ______________________________________________

City: ______________________________________________

Province: ______________________________________________

Phone Number: (_______)-_______-_____________

I agree to have the amount charged to my credit card for the computer system bundle.

Credit Card Type: VISA: ____

Master Card: ____

Card Holder Name: __________________________________________ Amount: $____________

Credit Card Number: __________________________________________Expiration: _____/_____

Signature*: ______________________________________________________________________

* I agree to abide the terms and conditions of my Cardholder agreement.