CHRISTOPHER HYLAND INCORPORATED CREDIT CARD AUTHORIZATION FORM lA Invoice #(s): (must list all invoice numbers here) Company Name: Cardholder Name C.C. Billing Address Telephone. Credit Card Type: Card Number: CC Verification Code Expiration Date: I authorize Christopher Hyland, Inc. to charge my credit card number indicated above in the amount of (this must be written out in longhand) : < if (S_OA: ) 1AM FULLY AWARE THAT CHRISTOPHER HYLAND, INC. DOES NOT ACCEPT RETURNS OR EXCHANGES AND THAT ALL SALES ARE FINAL. MY SIGNATURE HEREIN BELOW CONFIRMS MY ACCEPTANCE OF ALL THAT IS STATED ABOVE Cardholder Signature: Z7__ alll Date:_ 14) i) ce D & D BUILDING SUITE 1710 979 THIRD AVENUE NEW YORK, NEW YORK 10022 TELEPHONE (212) 688-6121 FAX (212) 688-6176 E-MAIL: INFO@CHRISTOPHERIIYLAND.NET EFTA00525153