STARLINE PACIFIC INC. CREDIT CARD AUTHORIZATION Fax completed form to 604-946-8716 I authorize Starline Pacific to use my credit card for purchases from Starline Pacific. I understand that my credit card will be charged before goods will be released. Credit Card#: _________________________ Name on Card: _________________________ Expiry Date: ____/____ Issuing Bank: _________________________ ============================================================ Address where credit card statement is sent Address:____________________________ Address:____________________________ City:_______________________________ Province:_______ Postal Code:_____ _____ Address where purchases will be shipped Address: ____________________________ Address: ____________________________ City:_______________________________ Province:_______ Postal Code:_____ _____ ============================================================ Drop shipments will be made only to the addresses shown above. Additional addresses must be listed on a seperate sheet, signed and dated by the card holder. ***You must also include a scanned image of the front and back of the credit card*** ***You must also include a scanned image of your drivers license to verify your identity*** ============================================================ I authorize the following people to use this credit card on my behalf for purchases from Starline Pacific. I also understand that anyone not listed below will not be able to place an order using this credit card. ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ I understand that I am obligated to notify Starline Pacific, in writing, if there are any changes in any of this information provided. Card Holder Signature: ___________________________________ Date: ____________ Company Name: ___________________________________ Phone#: ____________ ****************************************************************** FOR THE SAFETY OF EVERYONE CONCERNED, THIS FORM MUST BE COMPLETED IN FULL AND SENT BACK TO US BEFORE YOUR ORDER CAN BE PROCESSED AND RELEASED. ******************************************************************