WINDOWS CASINO
Credit Card Charge Authorization Form

Print out this form and fax it to Windows Casino, along with a 
photocopy of a valid official picture identification card (driver's
license, passport, etc.), your credit card billing statement and a 
utility bill (phone, electric, gas, etc.) with your name and address
as it appears on your credit card billing statement and your Windows
Casino account. 
_____________________________________________________________________

This form confirms your request for payment by Visa/MasterCard.

Your signature below constitutes your agreement to pay the amount 
specified below, and authorizes Windows Casino to obtain credit 
approval from said credit card company.

You must sign this agreement as well as the credit card authorization 
form below.

I, ______________________________, hereby authorize Windows Casino to 
charge my credit card account(s).  I affirm that I am at least 18 
years old and that I am legally authorized to use the credit card 
account number(s) specified below.  Furthermore, I understand and 
agree that the charges specified below are irrevocable and may not be 
charged-back at any time in the future.


SIGNATURE: x______________________________________.  

Address: ___________________________________________________________.

Phone #: _____________________. 

Date: _________________    

Authorization for Deposits to Windows Casino Account

Per my request(s) through their online credit card processing system,
I hereby authorize Windows Casino to charge up to $_____________ per 
month on the following credit card account(s):

Credit Card #:                     Expiration Date:




SIGNATURE: x_____________________________________________.


Cardholder acknowledges receipt of goods/ services in the amount 
(US Dollars) of the total shown herein and agrees to perform the
conditions set forth in their cardholders agreement with the user.

_________________________________________________________________

Notary Acknowledgment

State 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 ___________________


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

FAX SIGNED FORM & LEGIBLE PHOTOCOPIES OF PHOTO IDENTIFICATION CARD, 
CREDIT CARD STATEMENT & UTILITY BILL. 

Windows Casino US Fax: +1(509)562-1275