CASINO FILIPINO ONLINE
Credit Card Charge Authorization Form

Print out this form and fax it to Casino Filipino Online, along with a photocopy
of a valid official picture identification card (driver's license, passport,
etc.), your credit card billing statement and a utility bill (phone, electric,
gas, etc.) with your name and address as it appears on your credit card
billing statement and your Casino Filipino Online account.
______________________________________________________________________________

This form confirms your request for payment by Visa/MasterCard.

Your signature below constitutes your agreement to pay the amount
specified below, and authorizes Casino Filipino Online to obtain credit approval
from said credit card company.

You must sign this agreement as well as the credit card authorization
form below.

I,__________________________________, hereby authorize Casino Filipino Online to
charge my credit card account as "FireCash/17981" I affirm that I am at
least 18 years old and that I am legally authorized to use the credit card
account number specified below. Furthermore, I understand and agree that
the charges specified below are irrevocable and may not be charged-back at
any time in the future.

SIGNATURE: x______________________________________.

Address: ___________________________________________________________.

Phone #: _____________________. City: _____________________________.

Date: _________________ State: _________ Zip/Postal Code: _______.

Authorization for Deposits to Casino Filipino Online Account

Per my request(s) through their online credit card processing system, I
hereby authorize Casino Filipino Online to charge up to $____________ per month
on the following credit card account

Credit Card #: __________________________________.

Expiration Date: _____________

SIGNATURE: x_____________________________________________.


Cardholder acknowledges receipt of goods/ services in the amount
( US Dollars) of the total shown herein and agrees to perform the
conditions set forth in their cardholders agreement with the user.

_________________________________________________________________



Notary Acknowledgment

State of ________________

County of ______________

On __________________________, before me, the undersigned, a
Notary Public in and for said County and State personally appeared
________________________________, personally known to me (or proved
to me on the basis of satisfactory evidence) to be the person whose
name is subscribed to the within Credit Card Authorization Form and
acknowledged to me that said person executed it.

Witness My Hand and Official Seal

______________________________________
Notary Public in and for said County and State

My Commission expires ___________________


PLEASE SIGN THIS FORM IN BOTH PLACES ABOVE IN FRONT OF A
NOTARY PUBLIC.

FAX SIGNED FORM & LEGIBLE PHOTOCOPIES OF PHOTO
IDENTIFICATION CARD, CREDIT CARD STATEMENT & UTILITY BILL.

Casino Filipino Online fax:(509)562-1275