	VISA/Mastercard
	Authorization Form


Your Name:      _________________________________________________
(Please Print)

Address:        _________________________________________________

City:   _________________________State:_____Zip Code:____________

Phone Number:   _________________________________________________

Rolling Thunder Games, Inc. Account Number:  ____________________

Credit Card #: 

	___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

Expiration Date:                            Card Type (Check One)

	_______________ (Month, Year)       ___ VISA  ___ Mastercard

Authorization Agreement:
	
	I authorize Rolling Thunder Games, Inc. to use my 
VISA/Mastercard to automatically purchase $ 60.00 of gaming credit, to be 
placed into my Rolling Thunder Games, Inc. account.  I understand that 
this $ 60.00 purchase will occur automatically whenever my Rolling Thunder 
Games, Inc. account balance is $ 0.00 or less.  I also understand that I may 
cancel this agreement at any time with a written notice to Rolling Thunder 
Games, Inc. and that any unused game credit in my account can be refunded 
if so requested.


Your signature: ______________________________________________


Mail completed form to:

Rolling Thunder Games, Inc.
P.O. Box 1240
Broomfield, CO 80038-1240
(303) 466-8600 Phone
