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					                                    LAM Systems, Inc.
                                    4700 Westport Drive
                                    Mechanicsburg, PA 17055
                                    Phone 717-697-7500         Fax: 717-506-0007

To Our Valued Customers:

Our credit card processing company requires certain procedures for processing credit cards over the
telephone and to insure we are in compliance we must have this form signed, authorizing use of your credit
card for purchases. We must be able to produce this document when requested by the processor. Your
personal, identifiable information will be kept confidential and stored in a secure environment. If you have
any questions, please do not hesitate to call us at (717) 697-7500.

Thank you. We appreciate your business.

                           CREDIT CARD AUTHORIZATION
I ___________________________________ authorize LAM Systems, Inc. to charge my

________VISA_______MASTER CARD ________DISCOVER_______AMERICAN EXPRESS

Account in the following manner:

         One order only in the amount of: $

         This and all future orders regardless of dollar total

         This and all future orders up to a maximum of $                                  per order.

If fees for shipping & handling have not yet been included in the above amount I also
authorize including and increasing the amount above by the amount invoiced for such
charges.

ACCOUNT #
CARDHOLDERS NAME:
COMPANY NAME:
CARDHOLDERS ADDRESS:
                                                                        ZIP
EXP. DATE:                                            CVV CODE
(CVV Code is the last three digits in the signature line on the back of your card. American Express’ four
digit codes are printed on the front of card, separate from card #.)


CARDHOLDERS SIGNATURE:

DATE:

				
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