rd 144 0 Visa 0 American Express Card Number Name on the card Expiration date Signature Please detach and return with patrnent Cri ri III* Nam Coxrnount. CHARTER SEAN LANCASTER BRISTOL ASSOCIATES STE 1100 1023 15TH ST NW WASHINGTON, DC 20005-2694 INVOICE 1901589 Invoice Date 06/24/2011 Exec