HE2003 Charity Auction Registration : Print, sign and fax to: (734) 477-9302 Your Username ________________________________ Your Full Name ________________________________ Daytime Phone ________________________________ SHIPPING Address __________________________________________ __________________________________________ City______________________ ST______ Zip__________ Credit Card Type of card: ___Visa     ___MC     ___Amex Card Number ____________________________________ Expiration Month___________ Year_______ Need to use more than one card? Yes, please call me: ___________ BILLING Address Exactly as it appears on your Credit Card __________________________________________ __________________________________________ City______________________ ST______ Zip__________ I hereby give permission to Audiogon Inc. to charge to the above credit card, any and all amounts resulting from my bidding activity at the HE2003 Charity Auctions. Signed:___________________________________ Date:______________