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Credit Card Authorization Form

Date________

This is to verify that I ____________________________ authorize Penncross Ranch Inc. to pay my account with the use of my Master Card, Visa, or American Express credit card.  Penncross Ranch Inc. has not stamped my card but will keep this letter and signature on file to Verify authorization.  Penncross Ranch Inc will only charge my Statement upon my authorization.

Master Card Number_______________
Expiration Date___________________
Name On Card___________________

Visa Number_______________
Expiration Date___________________
Name On Card___________________

American Express Number_______________
Expiration Date___________________
Name On Card___________________

Signature__________________