Please print out this form, fill it in and follow instructions on it.

Credit Card Holder Consent & Agreement Form

We apologize for any inconvenience this form may cause you, but we thank you in advance in helping us fight credit card fraud.

CREDIT CARD AUTHORIZATION AGREEMENT

I, ................................................... hereby authorize Washington Courier, Inc. to put through a charge to my credit card.

My credit card number is ........-........-........-........ EXP. ..../....
Circle: Visa - Master Card - AMEX

The amount of the charge is to be $........................ PLUS additional charges, if applicable.

THE ADDRESS MY BILLING STATEMENT IS RECEIVED IS:

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I hereby authorize Washington Courier, Inc. to charge my credit card as described and for payment of the following services. I understand that Washington Courier is not liable for airline or delivery agent delays.

CARDHOLDER SIGNATURE x......................................

***To complete this transaction, please photocopy the front and back of both your driver's license and credit card. Fax this form and photocopy described above to Washington Courier at 703-518-8869. All transactions are subject to approval by your credit card company.