Credit Card Authorization Form

I authorize SportsOptions to charge $___________________ to my credit card listed below for SportsOptions service for the month(s) of: ______________________________________ .

Account: __________________________

Customer Name: _________________________________________________________________

Customer Phone Number: (____) _______________________________________

Cardholder Name: ________________________________________________________________

Cardholder Address: _______________________________________________________________

City: ________________________   State: _____________________   Zip: __________________

Cardholder Phone Number: (____) _______________________________________________

VISA   MC   AMEX  (Circle One)

Credit Card Number: _____________________________   EXP.: _________  CVV #: _________

Cardholder Signature: _____________________________________________________________