LAW OFFICE OF
                      DAVID ALAN DARBY
                       P.O. Box 12427
                    Tucson, Arizona 85732
                              
         CREDIT CARD CHARGE AUTHORIZATION AGREEMENT


     I,  _______________________________, the holder of  the

following credit card (check one, please):
     
VISA  ___ MasterCard ___ American Express  ___ Discover ____
     
Card  Number:  ___________________________  Exp Date ___/___  

with a three digit security code of __|__|__ on the back of 

the card, hereby  authorize The Law Office  of  David  Alan 

Darby,  in Tucson, Arizona to charge my credit card in  the 

amount of:$_________________________________________________ 
  
for attorney’s fees for legal representation for ___________

___________________________________________________________.


     I  further authorize the Law Office of David Alan Darby

to charge my credit card each month beginning the ______ day

of  __________, 2003 in the amount of $____________ for  the

period  of  ____  months for attorney’s fees  for  continued

legal representation.

Cardholder: ________________________________________________

Signature: _________________________________________________

Company: ___________________________________________________

Address: ___________________________________________________
             Where you receive your credit card statement

City, State, Zip:___________________________________________

Telephone: (_______) _______________________________________

Date: ______________________________________________________

Fax or email this completed form to 
Law Office of David Alan Darby 
Direct Fax: (520) 620-0818
Email: david@arizona-dui-defense.com