Please provide all the information requested below so that we process the event charges. We ask you to please sign and date the form before submission. Please fax the completed form to MAR Sportscards.com (609)561-9428

Cardholder Information:

Name as it appears on the credit card: _________________________

Card type: Visa MC Amex Diners/ Discover (Please circle)

Account type: Individual personal / business credit card (Please Circle)

Corporate Company Name: _________________________________

Account number: _______________________________________Exp. date: ___/___/___

CRV #: _________ (back of card ((Visa/MC)) Front upper right ((AMEX))

Address:______________________________________________
(where statement is mailed)

City, State and Zip:______________________________________

Phone number: __________________________________________

Fax or alternate number: ___________________________________

I certify that all information is complete and accurate. I hereby authorize MAR SPORTSCARDS to collect payment for all charges as indicated in the attached invoice(s) by processing a charge to the credit card listed above. Charges must not exceed ________________ . I certify that I am the authorized signer of the credit card listed above.

Cardholder name: (Printed) _________________________________

Cardholder signature: ________________________________Date:___/___/___