Authorization to charge your credit card.

Please print, fill out all of this form, and fax back.

Name of cardholder:

Statement Address:                        

City, State, Zip:

Phone #:                                                           Fax#:

Credit Card Type:                Credit Card #:                                

Expiration Date: 

Last 3 digits of number above signature line on back of card :_______

I authorize Cobweb Electronic Parts Ltd to charge my credit card $___________ in Canadian $(We can only take charge’s in local currency) for invoice #___________

The currency exchange rate today is _______

I agree that a faxed copy of this document is acceptable for verification purposes.

Name (print): _________________________Signature:______________________

Date: ____________________

Please fax this completed authorization form to Cobweb Electronic Parts Ltd              705-878-0589.