King R/C -- Authorization for Phone/Mail Credit Card Purchase

Please completely fill out the form. Your order cannot be shipped unless
all information is supplied. Please print. You can FAX the completed
form to King RC at 336 983-9810 or you can mail the form to us at the
following address:

King RC
P. O. Box 897
King, NC 27021

Name __________________________________________________________________

Address _______________________________________________________________

City ______________________ State____ Zip ________ Country ____________

Phone (Work)________________________ (Home)____________________________


       Credit Card Front           |        Drivers license or Passport
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 (place legible photocopy here)    |      (place legible photocopy here)
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       Credit Card Rear            |
 (place legible photocopy here)    |
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Credit Card Number ______________________ Expiration Date _____________

I, _____________________________________, do authorize the purchase of
             (print name)

$_______________________ from King R/C, King, NC 27021 to be charged to
 my credit Card and shipped to above address.

______________________________________________
		(signature)