Credit Card Authorization Form

In order for us to accept and bill your credit card, please complete all fields, SIGN and date, and fax it to  901-861-2373 or return via mail to Online Suites.
Please provide the following information as it appears in your order. All information kept on file is strictly confidential.

Contact/Billing Information: (as shown on credit card)

Full Name:                                                                    Country:

Company:                                                                     Zip/Postal:

Address:                                                                       Phone:

City/Town:                                                                   State/Prov:

Email:                                                                           Domain name:

Credit Type:(circle)         Discover                Visa                 MasterCard                  American Express

Credit Card#:                                                                                       Exp. Date:

Amount:(USD$)

One Time Use: I hereby authorize Online Suites LLC to charge the indicated credit card the amount indicated above. This is a one-time charge authorization.  I am NOT authorizing Online Suites LLC to setup my account within a recurring billing system – rather, I prefer to pay by check or money order on all future invoices.  I understand that if I wish Online Suites LLC to charge any balances to my credit card in the future, I will need to submit another authorization form at that time or choose the selection below.

 Recurring Billing: I hereby authorize Online Suites LLC to charge the indicated credit card my quarterly web hosting fees, as currently applies for the hosting account plan I requested at the time of account signup.  I agree that this is a periodic charge that will be made according to my billing cycle (quarterly), and that to terminate the recurring billing process I must cancel in writing.

Authorization:
I hereby authorize Online Suites LLC to charge the indicated credit card.  I agree that this is either a one time or periodic charge that will be made as indicated above.  To terminate the recurring billing process, if selected,  I must cancel in writing, otherwise the account will be manually invoiced and payment made via check, money order or wire.  I understand that all account cancellations must be made in writing.  I will not dispute Online Suites LLC’s recurring billing with my credit card issuer so long as the amount in question was for service rendered prior to my canceling my account in the manner required.   I agree that if I have any problems or questions regarding my Online Suites service, I will contact Online Suites for assistance, using the contact information located on their web site at www.OnlineSuites.com   I agree that I will not dispute any charges from Online Suites LLC unless I have already attempted to rectify the situation directly with Online Suites and those attempts have failed.  I authorize Online Suites LLC and their sponsoring agency to run an address verification search. This verification process is a security measure to protect me, the client, from illegal fraud against my credit card. I guarantee and warrant that I am the legal cardholder for this credit card, and that I am legally authorized to enter into this one time or recurring billing agreement with Online Suites LLC

 

 

Signature of Card Holder: _______________________________ Date: _______________________