PORCELANOSA* TILE / KITCHEN / BATH CREDIT CARD AUTHORIZATION FORM If you would like to charge a purchase to your Visa or MasterCard, AMEX please do the following: 1. Print out the form 2. Completely fill out the form below (Please print clearly). 3. Sign the form and FAX it back to 917-289-1228. Attn: Marisa Bordonaro 4. IMPORTANT: A new authorization form is needed for every charge. l, a , authorize Porcelanosa New Jersey, (CARDHOLDERS NAME EXACTLY AS IT APPEARS ON THE CARD) 475. 53 to charge my credit card set forth below the amount of $ USD. This payment will be applied to order number Card Type: VISA / MASTERCARD KAMER) CIRCLE ONE) Credit Card #: Security Code ** Expiration Date: 05 w | 16 Billing — (EXACTLY AS IT APPEARS ON YOUR STATEMENT) City: P| State: i Zip Code: : | My signature below confirms that | (a) fully acknowledge this purchase and understand the charges as set forth above; (b) have authorized Porcelanosa New Jersey, Inc. to charge the amount to the card number set forth above; (c) understand that these charges will be billed on my next credit card total amount according to the card issuer agreement. (PRINT CARDHOLDER’S NAME) ** THE FOLLOWING PAGE LISTS THE LOCATIONS FOR THE NECESSARY CODE: CREDIT CARD AUTHORIZATION FORM SECURITY CODE LOCATIONS 600 ROUTE 17 NORTH, RAMSEY, NEW JERSEY 07446 « PHONE (201)995-1310 » FAX (201) 995-1960 EFTA00521204

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PORCELANOSA® TILE / KITCHEN / BATH ** FOR YOUR SECURITY, PORCELANOSA HAS IMPLEMENTED AN ADDITIONAL FRAUD PREVENTION TOOL. OUR NEW SECURITY MEASURE REQUIRES THE ENTRY OF A “SECURITY CODE” NUMBER ON VISA, AND MasteRCarRD. THIS NUMBER IS A SECURITY FEATURE FOUND ON THESE TYPES OF CARDS ISSUED SINCE 1998. By OBTAINING THIS NUMBER, WE ARE ENSURING THE HIGHEST LEVEL OF SECURITY FOR OUR CUSTOMERS. Visa and MasterCard * 3 digits in length * On back of card, immediately following the account number in the signature panel Account Number Security Code 600 ROUTE 17 NORTH, RAMSEY, NEW JERSEY 07446 + PHONE (201)995-1310 + FAX (201) 995-1960 EFTA00521205