IDSYP PAYMENT

AUTHORIZATION FORM

PLEASE COMPLETE ALL INFORMATION

Cell (599) 557-1510/557-9431         Tel (599) 544-2408 Ext. 6001              Fax (599) 544-2906

                  IDSYP is located at Yacht Club Isle de Sol, Simpsonbay, St.Maarten N.A.

Yacht Name

Name of Captain

Name of Chef/Steward/ess

Credit Card Information

Type of Card

Name on Card

Expiration Date (mm/yy)

Billing Address

By signing below, I.D.S. Yacht Provisioning N.V. is authorized to charge the above account for orders placed.

Signature of Card Holder

For Office Use Only: