CREDIT CARD CHARGE AUTHORIZATION

To pay for my recent website advertising order, I hereby authorize PowerTools Software to charge my credit card as detailed below. Amount to Charge:                                                  Date:                                                  Type of Card:  ___ Visa   ___ MasterCard Card Number:                                                                                  Expiration Date:                                                  Security Code:                                                  Name on Card:                                                                                  Billing Address:                                                                                  City, State, Zip:                                                                                  Cardholder Signature:                                                                                  Print Name:                                                                                  Please Fax back to 1-800-497-2181