AUTOMATIC BILLING AUTHORIZATION FORM

PTSI’s Client Name: Harris and K, Inc. d/b/a Binger Springs

FROM CREDIT CARD:

I authorize Premier Trade Solutions, Inc. to charge my bill on behalf of Binger Springs directly to the credit card(s) listed below:

Primary Card Account Contact & Payment Information

_________________________________ _________________________________ Name on Credit Card (exactly as printed on card) Company Name

_________________________________ _________________________________ Address for Credit Card (Number & Street, Suite #) Contact Name Phone Number

_________________________________ _________________________________ Address for Credit Card (City, State Zip) Fax Number or Email Address (For Receipts)

_________________________________ _________________________________ Credit Card Number Invoice Number Invoice Amount ______________ _________________ _________________________________ Card Expiration Date 3 Digit Security Code Signature Today’s Date (MM/YY) (located on back of card) Bill all charges to the above card.

Premier Trade Solutions, Inc will fax or email a receipt to the above fax number or email address within 48 hours of processing the charge.