PLEASE READ CAREFULLY

I, hereby state the above information is true; and I give full authorization to Triplow.com to charge the above mentioned amount on my credit card. I shall not DECLINE, REJECT OR CHALLENGE the amount charged on my credit card for the above transaction. Please fill out this form, sign and e-mail us with a scanned copy of your credit card (front & back) and the card holder’s Driver License to INFO@TRIPLOW.COM