CREDIT CARD CHARGE AUTHORIZATION

 Vehicle Year/Make/Model______________________________________________________

 VIN or Stock #___________________________________________________

 I authorize Tichenor’s Auto to charge my:    ____MasterCard     ____Visa  

 Card #:________  ________  ________  ________    Total Amount:_______________ 

Exp. Date:_____/_____  Card Verification #:__________ (The final 3 digit # on the back of the card.)

 I understand that my signature on this form will serve in lieu of my authorized signature on the credit card slip and that I authorize Tichenor's Auto to charge my credit card the full amount listed above.  I understand that I am purchasing a salvage vehicle that will need repairs and once my order has been processed and shipped that I may not cancel my order. If I refuse my order once it has been shipped, I agree to be responsible for all shipping and handling charges both ways.

 I have read and fully understand the above conditions.

 Signed:______________________________________________________ Date:____________

                               Your address as it appears on your credit card statements

Name (As it appears on the credit card)_____________________________________________

Address:_____________________________________________________________________

City:_______________________________________ State:____________ Zip:_____________

                   Name and address you want on the title and invoice if different then above.

Name:_______________________________________________________________________

Address:_____________________________________________________________________

City:________________________________________ State:____________ Zip:____________