Date: …………………………………………………………………….

Name of the holder name: …..…………………………………………….….

……………………………………………………………..

Address where bank statements are received: ….……………………………………..……………………………………

By hereby authorize to process the charge to my credit card on behalf of: (NAME).
…………………………………………………………………………………………….. the amount of $ 90,000.00 MXN
(NINETY THOUSAND MEXICAN PESOS) that correspond payment for: 15 PEOPLE CENA NEGRA.

Charge has to be processed to the following credit card:

TYPE: ………………………………………………………………………………………………….……………………………………………

Complete number VISA/ MASTERCARD/ AMEX: …..………………………………………………………………………….

Name of the Credit card Holder: ….………………………………………..………………………………………………………..

Expiration date: ….……………………………………..…………………………………………………………………………………….

Security code: ………………………………………………………………………………………….………………………………………

I hereby certify that I am the authorized person to use of the credit card information
here provided.

We can´t make charges in USD, all charges will be processed in Mexican

pesos according to internal exchange rate.

** KINDLY RETURN THIS FORM VIA FAX OR EMAIL, WITH A COPY ON BOTH
SIDES OF THE CREDIT CARD AND AN OFFICIAL ID, BOTH SIDES AS WELL**

………………………………………………… ………………………………………………

Signature Credit Card Holder Date