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Cardholder Letter of Acceptance

I, __________________________________, authorized user of the credit card noted below, acknowledge
            Please Print Full Name

the transaction in the amount of $ ________________________with the merchant PNG Publications on

(approximation) the transaction date of ____ /_____ /_______ and request my bank release these
                                                                MM  /    DD   /   YYYY

funds to PNG Publications.

Cardholder Signature: _______________________________________

Date Signed: ______________________________________________

___________________________________________________

Note... We only accept Visa and Mastercard.

Credit Card No: ____________________________________________

Name (as it appears on Credit Card): ___________________________

Expiration Date: ___________________ Billing Zip: ________________

E-mail: ___________________________________

Phone: ___________________________________

Fax: _____________________________________

Please return this form to the attention of Dr. Elbert D. Glover (eglover1@umd.edu). If you wish to mail forward to: Elbert D. Glover, PNG Publications, 2205-K Oak Ridge Rd. #115, Oak Ridge, NC 27310 USA.

For other methods of delivery, please contact Dr. Glover at (301) 405-2029.