EFTA00616674.pdf

Data Management, Inc 3322 West Loop 306 San A olo TX 76904 CREDIT CARD AUTHORIZATION Please print out this form, till It out, and return fax to DMI at to the attn of Christina. Card Holder Billing Information: (This address must match billing statement) Company: Credit Card Billing Address: New York Strategy 457 Madison Ave. Floor 4 Phone Number: City: New York St: NY Zip: 10022 ono tromma Terms of Purchase: (Please Print Clearly) en arew I?erlargive Data Management, Inc permission to charge the amount of $ 127.00 for this purchase (including any applicable shipping and taxes) to the credit card below. I also authorize, only if selected below, Data Management, Inc. to charge this card for future purchases originated by myself or others at this Company. Please this credit card number and authorization on file for any future purchases. (Check One Please) Please consider this single form to be authorization for all future purchases 0 I will fill out an authorization form each time I make a credit card purchase from DMI. Credit Card Information: Please check one: El VISA 0 MASTERCARD 0 AMERICAN EXPRESS 0 DISCOVER For security purposes, when lazing or emaifing, at your discretion, legit free to leave the Credit Card number field blank, and telephone your sales representative directly to provide the CC number for processing. Credit Card Number: Expiration Date: 05/10 txxxx.xxxx.xxxx-xxxxi (MM-VY) Name as it appears on Credit Card: Signature of Authorized Purchasen...M _sea .i : 4:7 I understand that the items purchased are not eligible for DNB's Money Back Guarantee and are non-refundable. ized Signature Date thio 7 EFTA00616674 TimeClock Plusn4 Invoice No. Customed Order Date by Data Management, Inc. p 306 76904 226956 129519 07/06/2007 SOLD TO SHIP TO New York Strategy New York Strategy Emad Hanna Jermane Ruan 457 Madison Ave Little St. James Island New York, NY 10022 6100 Red Hook Quarters B-3 Saint Thomas, VI 00802 Rep Entry Method of Shipment Method of Payment MMURCHISON MMURCHISON UPS INTERNATIONAL Visa %. 05/2010 Stock No. Ordered Shipped Description Unit Cost Total 10-10 1 Money Back Guarantee Waiver 0.00 0.00 io-si6 1 V5 Replacement Media 48.00 48.00 Express Customer Invoice This is the ONLY invoice you will receiwc...-..- . 1111I11VIIIVIIIVIIIV111IH VIII Subtotal: S&H: Tax: 48.00 79.00 0.00 Total: 127.00 EFTA00616675