CREDIT CARD AUTHORIZATION FORM

I, _________________________________________________, hereby authorize RCG

Accounting & Associates, Inc. to charge my credit card account in the amount of
$ __________.

Type of Card: □VISA □MASTERCARD □AMEX □DISCOVER

Credit Card Number

___________________________________________________________________

Expiration Date ___________ CVC Code (located on rear) __________________

Credit Card Billing Address

Street: ___________________________________
___________________________________
City: ___________________________________
State: _________ Zip Code: _______________
Telephone: ___________________________________
Email: ___________________________________

Cardholder’s Signature

__________________________________________________________________

Date _________________________

Your completion of this authorization form helps us to protect you, our valued customers,
from credit card fraud. All information entered on this form will be kept strictly
confidential by RCG Accounting & Associates, Inc.

Complete and return via email.

You may also fax all documents required to: 954-862-2223

9000 Sheridan Street

Suite 138
Pembroke Pines, FL 33024