*a THE FOLLOWING PAGE LISTS THE LOCATIONS FOR THE NECESSARY CODE: PORCELANOSA' TILE / KITCHEN 1 BATH CREDIT CARD AUTHORIZATION FORM If you would like to charge a purchase to your Visa or MasterCard, AMEX please do the following: 1. Print out the form. 2. Completely fill out the form below (Please print clearly). Sign the form and FAX it back to-. Attn: 4. IMPORTANT- A new authorization form is needed for every charge. . authorize Porcelanosa New Jersey, (CARDHOLDERS NAME EXACTLY AS IcPEARS ON THE CARD) to charge my credit card set forth below the amount of $ . l USD. This payment will be applied to order number9a0:40 11— Card Type: VISA f MASTERCARD CIRCLE ONE Credit Card # Security Code ": iration Date:OG / I ED Billing Address: (EXACTLY AS IT APPEARS ON UR STATEMENT) City: 0(20 C,Ite-K- State: M Zip Code: I0021 My signature below confirms that I (a) fully acknowledge this purchase and understand the charges as set forth above: (b) have authorized Porcelanosa New Jersey, Inc. to charge the amount to the card n mber set forth above; (c) understand that these charges will be billed on my next credit card st tement; a • • ) • ree to •a the above total amount according to the card issuer agreement. SIGNATURE PRINT CARDHOLDER'S NAME CREDIT CARD AUTHORIZATION FORM SECURITY CODE LOCATIONS 600 ROUTE 17 NORTH. RAMSEY. NEW JERSEY 07446 • PHONE • FAX EFTA00521208

PORCELANOSA@ ME/KITCHEN/BATH •• FOR YOUR SECURITY, PORCELANOSA HAS IMPLEMENTED AN ADDITIONAL FRAUD PREVENTION TOOL. OUR NEW SECURITY MEASURE REOUIRES THE ENTRY OF A "SECURITY CODE" NUMBER ON VISA, AND MASTERCARD, THIS NUMBER IS A SECURITY FEATURE FOUND ON THESE TYPES OF CARDS ISSUED SINGE 1998. BY OBTAINING THIS NUMBER, WE ARE ENSURING THE HIGHEST LEVEL OF SECURITY FOR OUR CUSTOMERS. Visa and MasterCard • 3 digits in length • On back of card. Immediately following the account number in the signature panel Account Number Security Code 1 • 4 • • 4 2 1 600 ROUTE 17 NORTH. RAMSEY. NEW JERSEY 07446 • PHONE • FAX EFTA00521209