|
|
Credit Card Authorization Click here to return to our website.
CREDIT CARD AUTHORIZATION FORM COMPANY ISSUED CREDIT CARDS ONLY: EFFECTIVE JANUARY 1, 2006 WE WILL ONLY ACCEPT COMPANY ISSUED CREDIT CARDS For fax order, e-mail order and telephone order credit card purchases: Please PRINT this and fill out completely. SIGN and DATE and either mail or fax to us. As soon as we receive the completed form along with the signed sales order, we will begin provisioning your order! **Please do not send credit card information over the Internet** PLEASE PRINT CLEARLY. EXISTING CUSTOMERs: You may use this form to update your credit card information. FAX THIS FORM TO: 619-582-4616 Cardholder's Name as it appears on the card:__________________________________________ Contact or Company E-mail Address:________________________________________________ Cardholder's Address ( NO P.O. BOXES)_____________________________________________ City_______________________________________________________________ State (or Country)___________________________Zip_______________________ Daytime Phone: ________________________________ Date:____________________________ Credit Card Type: MASTERCARD_____ VISA_____AMEX______ Credit Card Number:_________________________________________ Expiration:_______________________ Amount of Purchase:___________
Date:__________________________________________ I hereby authorize Masterline Technologies, Inc. to charge the above listed credit card for the Initial amount stated on the Sales Order form and if applicable, makes charges for any applicable recurring fees, modification fees, termination fees, and reactivation fees for the duration of the service agreement. I agree to keep a valid credit card on file at all times. I understand that an expired card may cause service interuption and may generate reactivation fees, late fees or other related charges. Masterline Technologies, Inc. 5305 Waring Road, San Diego, CA 92120 (619) 342-4696 Tel (619) 582-4616 Fax |