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Item description_________________________________ Stock#___________________

Card Type (Please check one of the following) Mastercard__________ VISA_____________

Card # ___/___/___/___/ ___/___/___/___/ ___/___/___/___/ ___/___/___/___/

Expiration Date ___/___/

CCV # (3-digit code on the back, on right) _____________

Name on card____________________________________________________________

Charge Amount/Deposit$___________________ Full Sale Amount$________________

Billing address of card holder:

_______________________________ Home Phone______________________

_______________________________ Work Phone_______________________

_______________________________ Cell Phone________________________

I __________________________________________________ Hereby authorize, Auto Express IA., LLC. to charge my credit card in the full amount mentioned above, and guarantee full payment without dispute. I also understand fully than I am purchasing a salvage vehicle, that will need to be repaired, and or, inspected by a salvage process that I am responsible for.

I understand fully that the above purchased vehicle may, or may not exceed my initial assumption or repairs needed to make this vehicle road worthy. I am 100% confident with my purchase and agree not to dispute any charges upon signing this document.

Signature of card holder______________________________ Date___/___/______