CREDIT CARD AUTHORIZATION
I authorize Mauck & Baker, LLC to process the credit card authorization below for the benefit of the Illinois Bible Colleges Association and to be held in Mauck & Baker, LLC’s trust account for use in the on-going litigation against the Illinois Board of Higher Education. Credit card information is confidential and kept secure. Name on card: ________________________________________________________ Billing Address: ______________________________________________________ Email for receipt: _________________________________________________________ Type of Card: Credit Card Number: Exp. Date: _______
______________________________ Security Code: _______ (the last three digits on back of card)
I hereby authorize Mauck & Baker, LLC, for the benefit of the Illinois Bible Colleges Association, to charge $_______________to the above referenced account.
PERSONAL GUARANTEE The undersigned guarantees performance of the financial provisions of this agreement. Card Holder Name (print) Signature of Card Holder
_______________________________________________ _____________________ Date: ________________