AUTHORIZATION AGREEMENT FOR PRE-ARRANGED PAYMENTS
Domain
Name:__________________________________________________________________
Customer
Name:________________________________________________________________
Credit Card: ___Visa ___Mastercard
Complete Name on
Card:_________________________________________________________
Card
Number:__________________________________________________________________
Card Expiration
Date:_____________________________________________________________
Check one:
____Payment Amount $_______.___ or
____variable amount if you will be adding
additional services (disk space, pops, etc.)
Check one:
____Number of Payments ______ or
____continuous until notification of
cancellation.
Other options
____Check here if you already have an
account with us and are just changing credit
card information.
____Check here if you would like to pay for
one full year in advance. This will
entitile you to one free month of hosting,
however, no refunds will be given.
I hereby authorize and request that Shadowlink WebHostPage
hereinafter
called COMPANY to effect payment for any amounts to be paid by
me, as
indicated above, to COMPANY as such amounts become due by
initiating debit
entries to my credit card and I authorize and request Bank/Credit
Card Company to accept any debit entries by COMPANY to such
account and to
debit the same to such account without responsibility for the
correctness
thereof.
Signed:________________________________________________________
Date:__________________________________________________________