Dear _____________________________

This is confirmation of your request for payment by your Visa/Master card.

Your signature below constitutes your agreement to pay the amount below, and authorizes Skytower Sportsbook and Casino to obtain credit approval from said credit card company.

You must sign this agreement as well as the Credit card authorization form below

I, _____________________________ hereby authorize Skytower Sportsbook and Casino to charge my credit card (below) the stated amount. I also understand the authorization will show up on my credit card as DMS, SFPAY.CO.UK,  Furthermore it is understood this payment is irrevocable.

Address: ___________________________________________________________

City: ________________________  State __________ & Zip:_________________

Phone Number: _____________________  User ID# ________________________

Deposit Date (s): ____________________________________

Description: __________________________________________________________________

Amount (s):________________________________________________________

Total: _____________________________________________________________

Credit Card #: _____________________________ Exp. Date: _______________

CVV code 3 or 4 digit number on the back of your card: _____________________

Purchaser Sign here: X_______________________________________________

Please fax to 1-720-293-4507

Cardholder acknowledges receipt of goods/services in the amount (US DOLLARS) of the total shown

Herein and agrees to perform the conditions set forth in their cardholders agreement with the user.

*Please send a COPY of your driver license and of your credit card with your fax approval document.