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Member _______________________ Member
#_________________________
I, ____________ _______________________, hereby authorize Greater Los
Angeles REALTORS® to charge my credit card as per the details indicated
below.
Visa Mastercard American Express Discover
$__________________________
* Amount to be Charged
* Credit Card
#_____________________________________________________
* Expiraon Date ____________ /____________
Month Year
* Oce Name
______________________________________________________
* Credit Card Billing Address
*
Street_____________________________________________________
*
City_______________________________________*Zip____________
Purpose of Charge: