| CREDIT CARD AUTHORIZATION FORM |
| (Please print
this page and Fax to 90 Minute Courier, Inc. - Fax No. (305)
759-6103 or mail to 6883 N.E. 3rd. Ave., Miami, FL 33138 - c/o Noemi Perez) |
| Account Number:_______________ |
| Name of Company:_________________________________________ |
| Company Address:_________________________________________ |
| City:___________________________ State:_______ Zip:__________ |
| Name of Card Holder:_______________________________________ |
| Company Name on Card:____________________________________ |
| Credit Card Number:________________________________________ |
| Expiration Date:____________________ |
| Type of Credit Card: Visa___ Master Card___ |
| Amer. Expr.___ Discovery___ |
| Billing Address:____________________________________________ |
| City:________________________ State:_______ Zip:_____________ |
| Work Telephone Number: ______________ Fax:________________ |
| Description of Charges:_____________________________________ |
| _________________________________________________________ |
| _________________________________________________________ |
| This signature authorizes 90 Minute Courier, Inc. to charge the above mentioned credit card the amount of the billed invoices that 90 Minute Courier Inc. will bill the above mentioned company. |
| Signature of Authorization_____________________ Date:_________ |
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