artefacto Credit Card Holder's Authorization August 12,2018 l &F i riwy p Arta facto to charge my credit card as follows: • Visa Master Card \-/ Amex • • Expiration Date: • Security code: • In the amount of: $ 20, O e Number: j hereby authorize Reggae "6,ss.:e cieros CM? ezeira/a/rtedZe p ceitc-44SeC IMPORTANT NOTE: PLEASE ATTACH A COPY OF YOUR DRIVER'S LICENSE. By signing below, I acknowledge the charges described here on. Payment in full to be made when billed or in extended payment in accordance with standard policy of issuing card Company. Name as it Appears on Card: Jet= r-R S 76/ 11-1 Billing Address: .9 E 7/S t City: Metal yo State: Zip: 0 0 Signature Date 17651 Biscayne Blvd Aventurn Fl 11I AO Phone: EFTA00524155