ACKNOWLEDGEMENT OF CARD BILLING

I, …………………………………………………, Have authorized the "( Merchant )"

" CISE ELECTRONICS CORPORATION " , to charge my ……………in the

amount of……………………………………………………………………………....................

$ …………….US dollars, for goods and / or services specifically descripted

as : ………..................………………..………………………………………………………………

………………......................…………………………………………………………………………….

Upon  receipt  and  acceptance  of  the   goods and /or  services, the
aforementioned Merchand will not have further obligations to me what
so ever including any commitment to provide warranties or refunds of
any kind relative to the goods and/or services descripted above.

My card number is:…...…..............…………………………………………..……....…

Exp. Date ( MM/YY) ……/…….

CVV2/CVC2/CID number:...............................................................

The CVV number is printed on the front or back of the card. For Visa and Master only the
last 3 digits. For Amex the number is on the front of the card and has 4 digits.

My name as it appears on my card is ...............………………………………..……

The billing address for my card is:....................................................

...................................................................................................

State/Province...........................Country..........................................

Phone:......................................

Sign Here…….......……………….........Date …………………….……………..…..... 2008.
               (Cardholder)

Send by Fax to: Cise Electronics Corp.
Fax number: 786 293 1076

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