LiquidationTime, Inc. PO Box 45917 Philadelphia, PA 19149 United States
Username:_____________________________Auction ID:____________

CREDIT CARD AUTHORIZATION FORM

I, ___________________________, hereby authorize LiquidationTime, Inc. to charge my credit card account in the amount of $____________

VISA_____

MasterCard______

Credit Card Number: __________________________
Expiration Date: ______ / ______ VID Code: __________

Credit Card Billing Address: Street_____________________________ _____________________________ City: ________________, State: ________ Zip Code: _______ - _______ Country: _________________ Telephone: ( ) _______ - ________

Shipping Address: Street:_______________________________ _______________________________ City: __________________, State: ________ Zip Code: _______ - __________ Countr:_____________________ Telephone: ( ) _______ - ________

As the credit card holder, I hereby authorize receipt of merchandise at the shipping address above.

________________________________ ______/_______/______

Cardholder’s Signature Date

(Optional) As the credit card holder, I also authorize LiquidationTime, Inc. to charge my credit card for future purchases verbally approved by me.

Authorization Valid Until: _________ / _________ Initials Here: ___________