SEP Internal Information:

Clients Name:____________________________, Date of event_____________,

House copy:__________, To Bkpg:__________, Bkpg Copy_____

Approval Code: AP_____________YY SEQ____, Posted_______, by_______, Date________

=============================================================================================

Scott Evans Productions

(www.theentertainmentmall.com, e-mail: evansprod@aol.com)

P.O. BOX 814028, Hollywood, Fl. 33081-4028, 954.963.4449, FAX: 954.967.8890

CREDIT CARD BY PHONE AUTHORIZATION FORM

1)PLEASE CIRCLE THE TYPE OF CREDIT CARD YOU WILL BE USING:

WE “ONLY” ACCEPT: MC VISA DISCOVER

2)CREDIT CARD ACCOUNT #____________________________________________________

3)3 DIGIT “V- CODE”____________________________________________________________

(for Mastercard and Visa, this is the non-embossed number appearing on the signature panel)

4)THE CUSTOMER SERVICE 800 # THAT APPEARS ON THE BACK SIGNATURE PANEL:

______________________________________________________________________________

5)CARDS EXPIRATION DATE:____________________________________________________

6)PLEASE CIRCLE THE TYPE OF ACCOUNT THE CARD IS:

PERSONAL ACCOUNT BUSINESS ACCOUNT

7)EXACT BUSINESS OR PERSONAL NAME AS PRINTED ON CARD:

_______________________________________________________________________________

8)CARDS BILLING ADDRESS:_____________________________________________________

9)CITY, STATE & ZIP:____________________________________________________________

10)CARDS BILLING (AREA CODE) & TELEPHONE #:_________________________________

I HEREBY AUTHORIZE DISTANT SHORES, INC. D/B/A

SCOTT EVANS PRODUCTIONS

TO CHARGE THE ABOVE NAMED CREDIT CARD ACCOUNT

IN THE AMOUNT OF: $______________ + applicable fees*

*+ 7%/ADMIN. FEE/PERSONAL CARDS OR* $______________

*+10%/ADMIN. FEE/BUSINESS CARDS* $______________

TOTAL CHARGE ACCEPTED** $______________

**SIGNATURE OF CARDHOLDER:_______________________/DATE:_

ü Please fill out this form & fax it back to us along with the signed-printed & dated contract to our Fax #954.967.8890.

ü Please provide a light photocopy of the cardholders drivers license/photo identification and copy of the credit card being used.

ü Please note: All fields must be completely & accurately filled out along with proper identification as requested. If ther are any discrepancies in the information provided, we will void the transaction.