Virgin Valley Disposal, Inc.
501 Riverside Road
Mesquite, NV.  89027
702-346-5396


AUTHORIZATION FOR CREDIT/DEBIT CARDS

I hereby authorize Virgin Valley Disposal, Inc. to initiate debits from my checking 
or savings  account named below.  I understand that I am responsible to notify 
Virgin Valley Disposal, Inc. of any changes to my checking or savings account.

NAME ON CARD: ____________________________________________________________________

COMPANY: _________________________________________________________________________

CARD TYPE: 	Visa			
		Mastercard
		Other ____________________________________________________________

CREDIT / DEBIT (circle one)

CARD NUMBER: _____________________________________________________________________

EXP. DATE: _______________________________________________________________________


This authorization is to remain in full force and in effect until Virgin Valley 
Disposal, Inc. has received written notification from me to terminate this 
agreement. Virgin Valley Disposal, Inc. and my bank shall have a reasonable 
opportunity to act on the request to terminate.

MY NAME___________________________________________________________________________

VIRGIN VALLEY DISPOSAL ACCOUNT #__________________________________________________

TODAYS DATE_______________________________________________________________________

SIGNATURE_________________________________________________________________________

A $25.00 processing fee will be assessed if there are insufficient funds in your 
account.

NOTEs & cOMMENTS__________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Official Use Only

Draft #_______________
Cycle#_______________
Processed By_________
Date_________________