AUTHORIZATION TO USE AND CHARGE CREDIT CARD

Date

Citra Metro Manila Tollways Corporation

3/F Toll Operations Building, Doña Soledad Avenue
Brgy. Don Bosco, Parañaque City

This is to authorize (Mr./Ms.) DEE CONCRETE, INC. ("Subscriber") to use, and for Citra
Metro Manila Tollways Corporation (“CMMTC”) and its Authorized Credit Card Bank Host (“Provider”) to charge the Credit
Card for the replenishment of the RFID Account based on the details provided below:

CREDIT CARD HOLDER'S DETAILS SUBSCRIBER'S DETAILS

Card Holder's Name ELIZABETH O. DEE Name DEE CONCRETE, INC.
Credit Card Number 5312-2801-0009-3848 RFID Account No.

Card Type □Mastercard

X □Visa □AMEx □JCB Plate No. ABO2874
Issuing Bank BDO Tel No./ Mobile No. 0917-5262031
Expiry Date 04/25 Email Address readymix@deeconpremier.com

Auto Replenishment □500 (Default) □1,000 □3,000 □5,000 □500 (Default) □1,000 □3,000 □ 5,000
X
Threshold Amount
Amount Other Amount (Please specify) 3,000.00 Other Amount (Please specify)

Further thereto, we hereby confirm that:

1) The above information for the Prepaid Toll replenishment is voluntarily disclosed.
2) This Arrangement shall be on a continuing basis unless terminated in writing by the Credit Card Holder, Subscriber,
and/or by Citra Metro Manila Toll ways Corporation.
3) We are responsible in updating the credit card details by submitting an updated Authorization To Use and Charge Credit
Card Form with the RFID Customer Service Center within two (2) months prior to the credit card expiration date to
avoid termination of this Arrangement.
4) In case a credit card is declined in an automatic replenishment transaction, this Authorization shall be terminated
automatically without prior notice.

Attached hereto to support this Authorization are a photocopy each of the front of the credit card and of the respective valid IDs
(bearing the photo and signature) of the Credit Card Holder and of the Subscriber.

ELIZABETH O. DEE _ ELIZABETH O. DEE

Credit Card Holder’s Printed Name & Signature Date Subscriber's Printed Name & Signature Date

TO BE FILLED OUT BY AUTOSWEEP RFID PERSONNEL

Received By Processed By
Date Date
Branch/Location