CHARGE AUTHORIZATION
CHARGE $400.00 FOR EVERY 500 PAGES OR FRACTION THEREOF TO MY CREDIT CARD: (Check one) ___ AMEX ___ Diners Club ___ Discover ___ Master Card ___Visa __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Card Number Expiration Date _______ ______ (Month) (Year) _______________________________________ Card Holder Name _______________________________________ _________ Card Holder Signature Date