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). 5. Sign the fom and FAX it back to’. Attn: 4. IMPORTANT: A new authorization form is needed for every charge. , authorize Porcelanosa New Jersey, (CARDHOL DERS NAME EXACTLY AS PEARS ON THE CARD) to charge my credit card set forth below the amount of $ Q 8 . \ USD. This payment will be applied to order number Dolo 10 {+ VISA / ee A ae ONE) Expiration vate 05 / | Lb Card Type: Credit Card # Security Code **: Billing Address: (EXACTLY AS IT APPEARS ON YOUR STATEMENT) City: Naw dork State: N UY Zip Code: | 002] 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 nymber set forth above; (c) understand that these charges will be billed on my next credit card ree to pay the above total amount according to the card issuer agreement. OAD CARD\HOLDER SIGNATURE (DATE) (PRINT CARDHOLOER'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 [I - Ax EFTA00521208

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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 Cope” NuMBER ON Visa, AND MasterCaro. 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 + FAX EFTA00521209