Mumpower Sign Supply Inc.

Credit Card Charge Authorization Form                                                                   Mumpower Sign Supply, Inc



Company Name:________________________________________________________________________________________


City:___________________________________State:__________________Zip Code:___________Country:______________

Phone Number:______________________________________Fax Number:_________________________________________

Email Address:___________________________________________________________________________________________

I hereby authorize Mumpower Sign Supply Inc. to use my credit card for purchases made from Mumpower Sign Supply Inc. I understand
that my credit card will be charged before goods will be released.  All sales are final and non-refundable.

Will this card be used for one time purchase only?  _____Yes or _____No

                                                          If Yes, total charge amount: US$__________________________

This card can be used for future purchases: _______________Yes or_______________No

Please check one: __________Visa _________Master Card ___________American Express _____________Discover

Card#:____________________________________________Card Code:____________Exp. Date (mm/yy):_________/___________

Print cardholder's full name as it appears on credit card:_____________________________________________________________

Credit Card Billing Address:____________________________Same as above or please write below:


City:____________________________________________State:_____________________Zip Code:_______________Country:______________________

Cardholder's Signature:________________________________________________________________________________________________________

The following persons are authorized to use this credit card on my behalf:

________________________________________________________   _________________________________________________________________

________________________________________________________   _________________________________________________________________

I understand that I am obligated to notify Mumpower Sign Supply Inc. if there are any changes in the authorized users. I further understand and agree that my
credit card account will be charged in the event the card is used by formerly authorized users, unless I notify Mumpower Sign Supply Inc. in writing of changes
in the aurhorized users.  Once an authorization has been made for a charge on my credit card account, Mumpower Sign Supply Inc. has the right to rely thereon
and I will not seek any reversal of credit card charges subsequent to their authorization.  CARDHOLDER'S SIGNATURE attests financial responsibility,
willingness and ability to pay invoices in accordance with Mumpower Sign Supply Inc.  Cardholder also acknowledges responsibility for any costs and expenses
incurred in collection of account by a third party.  This authorization shall be renewed upon credit card's expiration.

Mumpower Sign Supply, Inc.
4257 Gate City Highway
Bristol, Virginia 24202
Phone (276)466-5943  * (1-800)368-5420  * Fax (276)466-5796   * (276)466-4751   *