I_________________________________authorize Capital Data, Inc. to
(name printed)

charge my credit card # ___________________________________________

expiration date___________ in the amount of $_____________US.

Equipment to be purchased:_________________________________________

___________________________________________________________________

I understand shipping charges will also be charged to my card along

with a $5.00 handling fee and the above amount referenced is for

goods only. I understand Capital Data will only ship to the verified

address on record for my credit card. My credit card billing address

is:___________________________________________________________________

______________________________________________________________________

I may request an alternate shipping address, if so I will list this

with my credit card company that address is _____________________

_______________________________________________________________________.

It is also understood that once the product has shipped, should I

change my mind regarding this purchase or wish to return the product

for other than defective, a 35% restock fee will be assessed and will

be deducted from the credit to my card. Products have 30 day warranty.

__________________________________________ _________________

(Signature) (Date)

**Customer Phone# ____________________________________

Customer Fax#_________________________________________

Customer Email Address:_______________________________

REV. 05/01