Credit Card FAX FORM

 Please print this form
Then complete and return it to us

For credit card payments please print and fax the following form to our offices within 48 hours.

If fax is not availble please send by mail to:

The Software Group
P.O. Box 687
Moorpark, CA 93020

Credit card accounts will be setup within 24 hours.

Fax Numbers: 775-254-1480

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The Software Group Charge Authorization

CREDIT CARD HOLDER INFORMATION


NAME: ___________________________________________________


ADDRESS: _________________________________ _______________


CITY:_________________________  STATE:____ ZIP:__________


CARD#:___________________________ EXP. DATE: ____________


Domain Name: __________________ 

Authorized (One Time / Monthly / Yearly) Charge $_________________
                                  (select one)

[  ] Charge Card     ( MC / VISA / Discover / AmExp )
                                          (select one)

I authorize The Software Group to deduct my normal monthly service as outlined in the order form for the above domain.

Card Holder
Signature:______________________________________________

Your
Signature:______________________________________________
                       (if different than above)

Your credit card statement will show a charge from
The Software Group