Date:___________

To:  MeadowBrook Farm,

This is to verify that I, ______________________________________ authorize MeadowBrook Farm to pay my account with the use of my Master Card, Visa or Discover credit card. MeadowBrook Farm has not stamped my card, but will keep this letter and signature on file to verify authorization. MeadowBrook Farm will only charge my statement upon my authorization.

Master Card Number:

Expiration Date:

Name on credit card:

Visa Card Number:

Expiration Date:

Name on credit card:

Discover Card Number:

Expiration Date:

Name on credit card:

Signature: