I, hereby authorize AZ Appraisal Group to charge my

           credit card account in the amount not to exceed: $.

           Card Number:

                                         VISA            MasterCard            American Express            Discover

           Expiration Date     3 Digit VID Code (Discover Card Only)

           Internet Transaction

           Credit Card Billing Address:

           Street:

           City: State:

           Zip Code:  Country:(If not US)

           Telephone:

           Authorization Only - Credit card will be charged if payment is not received within 30 days.

                                                             [If you prefer to print and fax this form, click the paynow icon >]