In lieu of my credit card imprint, I hereby authorize Electronic Development Labs, Inc. to charge my credit card
for payment of merchandise purchased, services performed, or repair services provided.

Amount to be charged:

Credit Card #

Exp. Date:

CVV2 Code

Card issued to:

Billing Address:
Address 1

Address 2

City

State

Zip

Phone number

Your email

By signing below, I acknowledge the charges shown. Payment in full is to be made when billed or in accordance
with the policy of the company issuing the credit card.
Signature of cardholder

Date

Note: Identification is required. Please provide a copy of the credit card (front and back).