GRID, INC.
4-20-16 IGUSA SUGINAMI-KU
TOKYO 167-0021 JAPAN
TEL:(813)3301-3047
FAX:(813)3301-8470

CREDIT CARD AUTHORIZATION AGREEMENT


TODAY'S DATE:_____________________


CREDIT CARD NUMBER:_____________-_____________-_____________-_____________


CREDIT CARD TYPE: (____)VISA CARD , (____)MASTER CARD


EXPIRATION DATE:________________________


I _____________________________ HEREBY AUTHORIZE GRID,INC. TO PUT THROUGH A CHARGE TO MY CREDIT CARD.


PLEASE ENTER THE FOLLOWING INFORMATION EXACTLY AS IT APPEARS ON YOUR CREDIT CARD BILLING STATEMENT.


CARDHOLDER'S NAME:_________________________________


CURRENT ADDRESS:_________________________________________________________________


TELEPHONE:_________________________________


FACSIMILE:_________________________________


THE AMOUNT OF CHARGE:JPY________________________________________________


CARDHOLDER'S SIGNATURE: X_________________________________________________


TO COMPLETE THE TRANSACTION, PLEASE PHOTOCOPY THE FRONT AND BACK OF BOTH YOUR DRIVER'S LICENSE AND CREDIT CARD.

THEN, FAX A COPY OF THIS DOCUMENT AND THE PHOTOCOPY DESCRIBED ABOVE TO GRID,INC. AT (813)3301-8470.