CREDIT CARD AUTHORIZATION

I, __________________________________________ (name) the owner and/or authorized buyer

for _____________________________________________ (firm name) hereby authorize Denali Seed Company to keep the following credit card information on file for a period of six months beginning as of the date of the first purchase using this card and as signer further authorizes Denali Seed Company to charge purchases made by the person(s) listed below to the credit card on this form.

Visa ______Master Card ______

Card Number ___________________________________

Card verification number _________ (the 3 digit number on the back of the card located after the credit card number)
Expiration date __________________

Billing Address:

Card Member __________________________________________

Billing Address _________________________________________

City __________________________ State __________ Zip ____________

I, the signer below, authorize the following Person(s) as identified on this list to make purchases from Denali Seed Company and to charge those purchases to the credit card identified on this form. Denali Seed Company will request to see the purchasers photo ID when an individual charges to this account.

1. ________________________________________________

2. ________________________________________________

3. ________________________________________________

4. ________________________________________________

Signed _______________________________________ Date ________________

Signers printed name __________________________________________

Denali Seed Company - P O Box 111425 - Anchorage, AK 99511
Phone (907) 344-0347 Fax (907) 522-1767
Email: seeds@denaliseed.com

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