(800) 447-3676
(407) 656-9742
Fax (407) 656-3353
 		Post Office Box 771548
48 North Woodland Street
Winter Garden, FL 34777-1548

Credit Card Authorization Form

The following information is provided to Data-Forms Resources, Inc. as
authorization to charge my credit card for the following:
Monthly Web Hosting
Technical Support
One-Time Only
Other
 PO#
Invoice#


Card Name:
Credit Card#
Type: Visa    Master Card    American Express    Discover   
Expiration# CCV#
Credit Card Billing Information
Company Name:
Individual Name:
Title:
Street Address:
City, State and ZIP Code:
Telephone #:
Fax #:
Comments / Remarks: