This form authorizes AASLS to charge the card holder credit card for services specified.

First Name:
Last Name:
Phone:
Fax:
Email:
Credit Card Type:	Select Card Type VISA MasterCard American Express Discover Diner's Club
Card Holder Name:
Credit Card Number:
Expiration Date:
Please Select One:
Add 20% Gratuity -----------------
Add 15% Gratuity -----------------
Add 10% Gratuity -----------------