CREDIT CARD AUTHORIZATION FORM

INSTRUCTIONS: 1. Fill out this form

2. Sign where indicated

Cardholder

_______________________________________________________

_______________________________________________________ Billing Address

_______________________________________________________

I authorize a charge against my credit card in

Credit Card (choose one) MasterCard Visa Discover

Card Number

_______________________________________________________

Security Code

____________________

Expiration Date

_______________________________________________________

E-mail Address

_______________________________________________________

* IMPORTANT NOTE A processing fee of 3% of the transaction total is charged for all

Signature: _____________________________ Date: ___________________

Renewal Fees: $_______ Processing Fee: $_______ (3% of transaction total *)

FOR: Renewal Fees

the following amount

fees paid by credit card

I authorize TFS Securities, Inc. to charge my credit card as specified. I authorize the financial

institution named above to charge my credit card for the amount indicated. This authorization is

for a one-time charge to my credit card for amounts due to TFS Securities, Inc. for Annual Renewals.

Annual Renewal Fees