TED Components  
                  601 Galahad Drive, Unit # 8; Oshawa Ontario L1K 1L19, Canada  
                      " Confidential Visa/Mastercard information/contract of Purchase"  
   
Name:                
   
Address:                
                 
                 
   
Tel:                
   
Fax:                
   
email:                
   
Card Home Bank:              
   
Visa/Mast. Number:              
Expiry:              
   
Name:              
   
   
Amount authorized :              
   
Special instructions              
               
   
   
   
By filling out this statement, I authorize TED Components to debit my credit card in the amount
indicated above. Failure to complete the transaction will result in legal actions to recover the 
cost of goods and services delivered and the cost of expediting the said amount indicated above.
   
   
I agree:        
   
   
Sample signature: