ZF SACCO CREDIT CARD AUTHORIZATION FORM | hereby authorize Sacco Carpet Corporation to charge my credit card in the amount of for the purchase listed below. ORDER INFORMATION Order #: Amount Charged: CREDIT CARD INFORMATION Visa AMEXO MasterCard Oo Cardholder Name: Credit Card Number: Expiration Date: Security Code: Billing Address: Cardholder Signature: Date: ** please fax completed form to ii’ Sacco Carpet Corp.520 ns 6" floor, New York, NY 10012 phone: fax: www.saccocarpet.com EFTA00521034