Solomon's Bargain Center Inc.,

 CREDIT CARD AUTHORIZATION POLICY

Date:___________________

Dear valued customer,

In order to protect our customers and our business we need you to provide the following information:
This is to certify that ____________________________gives permission to Solomon's Bargain Center Inc. to charge my Visa / Mastercard (CIRCLE ONE)

Account #_______________________ Expiration Date______/_____ (mo/year) for the amount of $___________________.

Signature:__________________________Date:_______/_______/________Phone:_______________

EMAIL Address:______________________

The Billing address of this card is as follows:

Address___________________________________
City/State/Zipcode __________________________
Country___________________________________

SOLOMON'S Bargain Center  INC.

14255 BEACH BOULEVARD

JACKSONVILLE, FLORIDA 32250

PHONE: (904) 223-0888

Fax: (904) 223-9408

URL: http://www.solomons.net/