Credit Card Authorization

I ___________________________________________, authorize “AAA Mister Beer Express” to
              (nombre y apellido)

charge $ ___________________, in my ____________________________, credit card #
                     (cantidad)                                        (tipo de tarjeta)

____________________________________ the expiration date is ____________________.
  (numero de tarjeta)                                                                       
      (fecha de expiracion)

Code CVV2 ______ (signature area of the back of credit card, it is the last 3 digits)

Date: __________________                                           Signature: _____________________
             (fecha de hoy)                                                                                 (firma)

Billing Address____________________________________________ Zip Code________________


                                         AAA Mister Beer Express, Corp
                                                  7125 S.W. 47th St.
                                                   Miami, FL 33155



Please Read !!!!!!!!!

Call AAA Mister Beer Express and speak with an agent before filling out the following form.
(may not apply in all sales)