MOST _ Associates_ Inc

							              MOST & Associates, Inc.
                              11300 N REVERE RD/ MEQUON, WI 53092-3555
          (262) 241-4014 / Fax: 253-369-7845/ E-mail: sales@mostcomputers.com


                Credit Card Purchase Authorization Agreement
Date ______/______/______                                            Customer name _____________________

      Visa                                                                                Personal Credit card
      Mastercard                                                                          Corporate
      Discover                                                                     

Account (and PIN) #                                                                 Expiration date:


Issuing Bank name:


Customer Service phone number: 800-



Name on Card                                                   Business Name

Title of Cardholder (if                                        Telephone
corporate/ business
purchase)

Driver’s License                                               Fax
(state and number)


Billing Address:                                               Ship to address:



                                Residential                                                   Ground (DHL)
       Address is:                                                   Ship method:              Other (please specify –
                                Commercial                                                   additional charges might
                                                                                              apply)
                                                               Credit Card
Item                                                           Approval Code


I am an authorized signer of and hereby authorize MOST & Associates, Inc. to bill the above credit card in return for
the shipment of computer products to the above ship to address.


X________________________________________________                     Date ______/______/______
Authorized cardholder signature

To complete this transaction, please fax a copy of this completed document and a photocopy of the front and back sides of
your credit card and driver’s license to MOST & Associates, Inc. at 253- 369-7845.

                                        Thank you for your business!!!