Contributor Occupation Joint Contributor Employer CREDIT CARD REPLY Please charge my contribution of $ to my credit card. K Visa K MasterCard K AMEX K Discover Account Number Expiration Date Name on Card Signature Mail to: Romney Victory, Inc. do Fifi Knott •190 Elizabeth Street, #6R •New

rm hereby authorize Publicide, Inc. to charge this credit card in advance for all Purchase Orders received. Type of Card: K VISA K MASTERCARD K AMEX K DISCOVER Credit Card Number: Expiration Date: CVC Security Code*: 'For MasterCard, Visa and Discover this is the last three digits on the numb