EFTA00186581

# STAVANTE CORPORATION
## credit card Services

use indicate Commercial Card Product type:

- **VISA**
- **MasterCard**
- **Corporate**

**company Name:** NIS LLC

**NIS LLC Product Type:** Business

**Company Number:** Corporate Account:

### **ECTION 1 - AUTHORIZED USERS**

| Name | Credit Line | Cash Advance Capability | Reporting Unit (Optional) |
| :--- | :---: | :---: | :---: |
| Dana Burns | 500 | "D" or % of Limit | Pin VN |
| others Maiden Name (Optional) | Social Security Number | Hajime telephone # (Optional) | Account Number 1 |
|劫holder billing address | 457 Madison Ave 4th FC | City New York | State NY |
| special Handling Instruction: Federal Express | Attn: Ribard Kabo | City | State |

**static address if different from Cardholder billing address:** City | State |

| Name | Credit Line | Cash Advance Capability | Reporting Unit (Optional) |
| :--- | :---: | :---: | :---: |
| Mothers Maiden Name (Optional) | Social Security Number | Home telephone # (Optional) | Account Number |
| Cardholder billing address | | City | State |

**Special Handling Instruction:** Federal Express
Plastic address if different from Cardholder billing address: City | State |

| Name | Credit Line | Cash Advance Capability | Reporting Unit (Optional) |
| :--- | :---: | :---: | :---: |
| Molbers Maiden Name (Optional) | Social Security Number | Home telephone # (Optional) | Account Number |
| Cardholder billing address | | City | State |

**Special Handling Instruction:** Federal Express
Plastic address if different from Cardholder billing address: City | State |

* Visa Purchasing Card Options*

* Visa Purchasing Card Options*

Financial Institution Name: [Signature]

Agent # [Date]