NOTARY ACKNOWLEDGEMENT

(Statutory Declaration/____________________)

Country:_________________________  State or Province 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:_________________

                                                                                                  SEAL OF THE NOTARY 

Note: Please be aware that an ink seal is required.

                                            Cardholder’s Signature:__________________________

                                            Credit Card’s Number  :__________________________
                                                                                  __________________________

PLEASE SIGN THIS FORM IN BOTH PLACES ABOVE IN FRONT OF A NOTARY PUBLIC.

FAX SIGNED FORM & LEGIBLE COPIES OF DRIVERS LICENSE OR SIMILAR, SIGNED CREDIT CARDS, CREDIT CARD STATEMENT  & OR UTILITY BILL TO FAX NUMBER: 011-506-248-0968 OR THROUGH OUR E-FAX : 1-866-413-6261