PLAY AND DEAL (TM) CASINO Credit Card Charge Authorization Form Print out this form and fax it to Play And Deal Casino, along with a photocopy of a valid official picture identification card (driver's license, passport, etc.), your credit card billing statement and a utility bill (phone, electric, gas, etc.) with your name and address as it appears on your credit card billing statement and your Play And Deal Casino account. ______________________________________________________________________________ This form confirms your request for payment by Visa/MasterCard. Your signature below constitutes your agreement to pay the amount specified below, and authorizes Play And Deal Casino to obtain credit approval from said credit card company. You must sign this agreement as well as the credit card authorization form below. I,__________________________________, hereby authorize Play And Deal Casino to charge my credit card account as "CompECash" I affirm that I am at least 18 years old and that I am legally authorized to use the credit card account number specified below. Furthermore, I understand and agree that the charges specified below are irrevocable and may not be charged-back at any time in the future. SIGNATURE: x______________________________________. Address: ___________________________________________________________. Phone #: _____________________. City: _____________________________. Date: _________________ State: _________ Zip/Postal Code: _______. Authorization for Deposits to Play And Deal Casino Account Per my request(s) through their online credit card processing system, I hereby authorize Play And Deal Casino to charge up to $____________ per month on the following credit card account Credit Card #: __________________________________. Expiration Date: _____________ SIGNATURE: x_____________________________________________. Cardholder acknowledges receipt of goods/ services in the amount ( US Dollars) of the total shown herein and agrees to perform the conditions set forth in their cardholders agreement with the user. _________________________________________________________________ Notary Acknowledgment State of ________________ County of ______________ On __________________________, before me, the undersigned, a Notary Public in and for said County and State personally appeared ________________________________, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within Credit Card Authorization Form and acknowledged to me that said person executed it. Witness My Hand and Official Seal ______________________________________ Notary Public in and for said County and State My Commission expires ___________________ PLEASE SIGN THIS FORM IN BOTH PLACES ABOVE IN FRONT OF A NOTARY PUBLIC. FAX SIGNED FORM & LEGIBLE PHOTOCOPIES OF PHOTO IDENTIFICATION CARD, CREDIT CARD STATEMENT & UTILITY BILL. Play And Deal Casino fax: 1-800-653-5504