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

                                             Office.
1800-819-5179

                                             Local    
305-551-2129

                                                Fax.
 1800-557-6014
Please Read !!!!!!!!!

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