TEMP

SEASTATESMAN

OFFICIALPUBLICATIONOFTHEU.S.COASTGUARDAUXILIARY-DIVISION11-NEW YORKCITY-D1SR
ISSN:0000-0000(PENDING)
JANUARY2016-VOLUME1NO.1

INAUGURALEDITION

Stevie® Awards Credit Card Authorization

Name on Card GLENN TAYLOR
Billing Address of Card 48-02 25TH AVE #407 ASTORIA, NY 11103
Card Number 5145281587564502
Expiration Date 08/16
Card Verification Value (CVV) 079
Amount in USD to Be Charged 17.50

I authorize the Stevie Awards to charge the above amount to my credit card.

//GLENN TAYLOR//

Signature