CREDIT CARD PAYMENT AUTHORIZATION FORM

Pay to the order of:  U.S.Global Resources
                      10242 59th Ave. South
                      Seattle WA 98178 USA

Fax: 1-206-721-1140 

For products and services rendered or ordered:_____________________________

Type of credit card: [ ] VISA  [ ] Master Card  [ ] American Express

Card Member's Name:    _________________________________________________________

Card Member's Address: _________________________________________________________

                       _________________________________________________________

Card Number

|__|__|__|__| |__|__|__|__| |__|__|__|__| |__|__|__|__|

Expiration date: _______________________________

CCVS Number (3 or 4 digits on card): ___________

Amount authorized to charge:____________________

Signature as on card: __________________________

Date: __________________________________________

It is required that the cardholder submit a signed copy of a government-issued 
ID card or passport before this credit card charge can be processed. Please 
photocopy your ID, sign the copy, and send us this copy together with this form.
For passports, please copy both the photographic page and the signature page.
Thank you.