AUTHORIZATION / MONIES ISSUANCE FORM I,_________________________, hereby certify that I am the cardholder for the below credit card(s) and agree to pay for the E-cash purchased under the captioned EFS account using the credit card(s) indicated below. I hereby acknowledge that the maximum amount of E-cash I can purchase for the EFS account is US $4,000 per month, and I authorize EFS to increase my maximum monthly amount to $5,000. I will take full responsibility for eventual fraud against my EFS account, and will take every precaution necessary to ensure that my user name and password are safe and secure. User Name: __________________ Credit Card Number: _______________________ Exp. Date__________ Signature: ____________________________ Date: _________________ PLEASE FAX THIS LETTER TO: (253) 276-2642 We thank you for choosing Casino On Air.