Thank you for your payment of our account opening

							                                                        .
Thank you for your payment of our account opening fee and the
order of a new international company!
In order to complete your credit card transaction, please complete and send this
form and:
       1. a copy of your government issued ID, and
       2. both sides of your credit card
via email with the scans attached to validate@capitalconservator.com
                                          or
                 via fax to any one of these automatic fax numbers:
             +44 (207681-1090 OR +1 (302) 295-0115 OR +598 (2) 623-5435

Please confirm the exact name choices for your company, including LLC, Ltd, SA,
etc, as appropriate. Please specify the jurisdiction for formation: __________________
1st choice: _____________________________               2nd choice: ____________________________
3rd choice: ____________________________                Company Type:________________________

                                          AUTHORISATION FORM
This is to confirm that by my writing my name and signature below, I have authorized Pro Secure Ltd., on
behalf of Capital Conservator Savings & Loan Limited to process electronic charges to my credit card with
the following number via their processor. I agree that this authorisation and the electronic record of my
transactions held by Pro Secure Ltd., on behalf of Capital Conservator Savings & Loan Limited shall be
used as the final determination to resolve any dispute regarding past or future transactions. I understand that
the electronic charges will appear on my credit card billing statement as Pro Secure PAYMENT.

The amount to be charged to my credit card is:                           USD

INFORMATION MUST BE EXACTLY AS IT IS ON YOUR CREDIT CARD STATEMENT!

Credit Card #___________________________ Exp. Date _____/_____

Name: __________________________________________ Date of Birth: ___/___/___

Address: _____________________________________________________

Address2: ____________________________________________________ (optional)

City: ________________________________State/Province _______________ (if any)

Postal Code or Zip: _____________ Country: _____________________

Telephone: _________________________ Email: _____________________________

Signature____________________________________________ Date: ____/____/____

                         All information provided is strictly confidential.