CG Macro MemoStd.dot Template

							                                  US COAST GUARD FINANCE
                                  CENTER CREDIT CARD
                                  AUTHORIZATION FORM

Name (Please Print): _____________________________________________

Social Security Number: __________________________________________

Address: _______________________________________________________

        _______________________________________________________

Telephone Number (including Area Code): ____________________________

Travel Order Number (TONO): _____________________________________

Payment Amount: ________________________________________________

Please charge my: ______________ Visa _________ Master Card

                (Debit, Discover, & Amex cards are not accepted)

Card Number: ___________________________________________________

Card Expiration Date: _____________________________________________

        Signature: _______________________________________________

PLEASE MAIL THIS FORM AND A COPY OF YOUR LETTER TO:

      COMMANDING OFFICER (OGR)
      USCG FINANCE CENTER
      1430A KRISTINA WAY
      CHESAPEAKE, VA 23326

OR FAX THIS FORM AND A COPY OF YOUR LETTER TO: (757-523-6734)
                                                        ATTN: OGR
__________________________________________________________________________

FOR OFFICE USE ONLY:

Clerk: _________________________________ Date: ________________________

Approval Code: __________________ Confirmation Number: _________________