AUTHORIZATION FORM

Dear Mr. Jack, (JACKIE TAILOR )

I, HERE BY AUTHORIZE JACKIES TO PROCEED WITH MY ORDER AS MENTIONED ABOVE AND TO DEBIT THE SUM OF FROM MY CREDIT CARD SPECIFIED BELOW.

CREDIT CARD NUMBER:

EXPIRY DATE : (DD/MM/YY)

FOR AMERICAN EXPRESS PLEASE MENTION THE FOUR DIGIT NUMBER APPEARING ON THE ENTER RIGHT HAND CORNER OF YOUR CARD TO PROCESS

(PLEASE FAX / MAIL OR EMAIL THIS LETTER TO JACKIES)

TEL : +(6602) 6560206-7 FAX : +(6602) 6533507

E-MAIL : jack@jackiestailor.com

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