NOBILIS ('/CSIIS - 1-1O/1;( pChl/S - 14/1-711.CATHICH/Clfr NOBILIS CREDIT CARD AUTHORIZATION Tel: Fax: Ship/Waive CFA: Hold for CFA Approval: Date: Nobilis Customer Number: Account Name: Pattern Number: Order Total: Ship to: sm: Quantity: VISA MASTERCARD AMERICAN EXPRESS Credit Card if: Expiration Date: / Name on Credit Card: Billing Address of card: Zip Code required: SIGNATURE: 3006 EMRICK BOULEVARD • BETHLEHEM, PA 18020 • FAX: EFTA00521212