I  HERE BY AUTHORIZE FIREBIRD SYSTEMS, INC.  d/b/a  "FIREBIRD-SYSTEMS.COM" TO CHARGE MY CREDIT CARD

Visa / MasterCard / Discover / AMEX      CARD  # ______________________________________________
           (Circle card type)

EXPIRATION DATE: __________________________   AMOUNT   $ ______________________________     FOR PRODUCTS AND SERVICES

I ORDERED THRU THE WEBSITE IN MY ORDER NUMBER _________________________  AND IN COMPLIANCE WITH ITS POLICY AND
TERMS OF SALE.

PLEASE SHIP MY ORDER TO THE FOLLOWING  BILLING / NON-BILLING ADDRESS:
                                                                               (Circle address type)
First Name: _________________________________________
                               (Print)
Middle Name: ________________________________________
                               (Print)
Last Name: __________________________________________
                               (Print)
Address 1: __________________________________________
                               (Print)
Address 2: ________________________________
                               (Print)
City: _____________________________________
                               (Print)
State: ________    Zip Code:  ___________________________
           (Print)                                        (Print)
                                                                                              _______________________
                                                                                                 (Signature As Signed On Card)

 * Attach a copy of  Identification / Drivers License &  both sides of the Credit  Card and fax to  (818) 349-8999.