CREDIT CARD AUTHORIZATION FORM

    Date       

    I hereby authorize Gateway Fencing, Inc. to charge my

       credit card account in the amount of $

                                        Shipping Included                Add Shipping  

                              

        Credit Card Number:

          Expiration Date :    /                VID Code:   

             Credit Card Billing Address                                  Requested Shipping Address

    Street:                          Street:

                                                             

        City:                                  City:     

        State:                  Zip Code:  -                           State:                    Zip Code:    -                                                           

 

                                         

Cardholder's Signature                                                                           

  As the credit card holder, I submit this form.  It represents my

 agreement to pay the total amount shown in compliance with the

 cardholder agreement.