CREDIT CARD CHARGE AUTORIZATION FORM

Date:

I, {NAMEONCARD}, hereby authorize Data Network Affiliates, Inc to charge my {CARDTYPE} credit card ending in
{LAST4DIGITSCC} for the amounts invoiced on invoice number {NUMBER} dated {INVIOCEDATE}. This verification
process is a security measure designed to protect me, the client, from illegal fraud against my credit card. I also agree to
pay the charge shown herein, according to my cardholder agreement. I guarantee and warrant that I am the legal card
holder for this credit card, and that I am legally authorized to use the credit card account number specified herein and to be
additionally bound by Data Network Affiliates, Inc. Policies, Terms and Conditions, Affiliate Agreement and instructions for
this transaction. I agree that if I have any problems or questions regarding my Data Network Affiliates, Inc service, I will
contact Data Network Affiliates, Inc for assistance, using the contact information on their web site. I agree that I will not
dispute any charges from Data Network Affiliates, Inc unless I have already made an effort in good faith to rectify the
situation directly with Data Network Affiliates, Inc.

RECURRING CHARGE AUTHORIZATION FORM

I, {NAMEONCARD}, authorize Data Network Affiliates, Inc to bill the credit card or debit card listed herein for the amount of
${RECURRINGAMOUNT} on a recurring basis, beginning on the date of {DATE} and thereafter charged every
{INTERVAL}. To terminate the recurring billing process I must cancel in writing. I understand that I will receive a receipt of
each charge via mail. I also agree to pay the recurring charge shown herein, according to my cardholder agreement. I
agree that any credits issued by Data Network Affiliates, Inc for any reason will not be refunded to my credit card, but
instead deducted from my next bill. I agree that if I have any problems or questions regarding my Data Network Affiliates,
Inc service, I will contact Data Network Affiliates, Inc for assistance, using the contact information on their web site. I agree
that I will not dispute any charges from Data Network Affiliates, Inc unless I have already made an effort in good faith to
rectify the situation directly with Data Network Affiliates, Inc, and those efforts have failed. I authorize Data Network
Affiliates, Inc and its Affiliate companies to run an address verification search. This verification process is a security
measure designed to protect me, the client, from illegal fraud against my credit card. I guarantee and warrant that I am the
legal card holder for this credit card, and that I am legally authorized to enter into this recurring billing agreement with Data
Network Affiliates, Inc. I furthermore affirm that I am legally authorized to use the credit card account number specified
below and to be additionally bound by Data Network Affiliates, Inc. Policies, Terms and Conditions, Affiliate Agreement and
instructions for this transaction.

DNA Account #:
Name On Card:
Card Ending In:
Expiration Date:
Billing Address: