Credit Card Authorization

To our Valued Customers:

Your privacy and security are very important to us. Growers Supply Co. strives to maintain current, accurate and
protected technology in order to provide you with a convenient method of payment for your account. We have updated
our current procedure to utilize an encrypted and information verification system through First Data which ensures that
once your card and information is entered, no one is able to view it again. Your card is auto processed on the 10^th of each month, unless this date falls on a weekend or statutory holiday.

*All areas of this form must be completed in full.

Growers Supply Co. Ltd Account Number or Account Name *

I/We *

hereby authorize Growers Supply Company Limited to debit my/our:

Credit Card Type *

VISA
Mastercard

Credit card ending in: *

(last 4 digits only)

CVV: *

(from back of card)

Name (as it appears on the card) *

Credit Card Billing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

(This address must match the billing address on your credit card, or payment will not be processed)

Dated: *

Signature *

If you are not currently enlisted in the above program, but you would like to be, please complete the information
above, send it to our office and call our finance team at 250.765.4500. We will take the additional information
over the phone to enter into our system.

We look forward to better serving you.

The Finance Team