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N-z0��r02-(J) <br />BOWERS MUSEUM <br />Credit Card Authorization ALyYeement <br />Name <br />0 b\, IC unw �Ih <br />Billing Address <br />SO4"\\u <br />City State Zip Code <br />Contact <br />� Number DCel(�l` 4� Business U Moine <br />EW41 Address <br />For the Damage Deposit, Please Use My: <br />Amex MasterCard Visa <br />S gl000.— <br />Amount <br />For Payment, Please Charge My: <br />Amex MasterCard Visa <br />Amount <br />Can the same Credit Card be used for the balance due? Yes No <br />5`5ul3 1501 50(sa I�qt 11-1-5 <br />�Cjarrd_N1 umber (�,\) — `I Expiration Date: CVC Security Code: <br />-i®z�SV"IC,tU— �Sla LAS._ <br />it appears on the <br />n — _ <br />Cardholder's Signature. <br />Upon Completion, Please Return This Payment To: <br />Bowers Museum <br />Special Events <br />2002 North Main Street, Santa Ana, California 92706 <br />32cs is: d; d13�,e 3U{7 zMeih r mental 1146�1:? t�idciines <br />