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Credit Card Payment Form

Date
 Contact Name
 Company Name
Mailing Address
Phone #
 Fax #
 E-mail address
This signature below authorizes Map Connection to charge my
current Map Connection monthly statement to my credit card
Card Type:   Mastercard   Visa  
Card Number
 Expiry Date
Name on Card
 Signature
Please print this form and fax it to (403) 266 0935
Attn: Martin/Kim

Map Connection Ltd. Wholesale Distributors

All prices subject to change without notice
#100 - 400 5th Ave. SW, Calgary, Alberta, Canada, T2P 0L6
Ph. (403)215-4058 Fax. (403)266-0935 E-mail: sales@mapconnection.com