WEBVISIONS PTE LTD /
ASIANFRONTIERS Network Services
(A Subsidiary of Webvisions)
ATTN: SALES DEPARTMENT
75 Science Park Drive
Cintech II, Singapore Science Park
#02-06/08, Singapore 118255
FROM: __________________________________
CASE NUMBER: ___________________________(if any)
DOMAIN NAME / ACCOUNT DETAILS: ___________________________
AUTHORIZATION TO CHARGE CREDIT CARD
COMPANY NAME:
EMAIL ADDRESS:
NAME ON CARD:
TYPE OF CARD: (Visa / Master) *
CREDIT CARD #:
EXPIRATION DATE:
BILLING ADDRESS
OF CREDIT CARD:
ACCOUNTS OR
DOMAIN NAMES
PAYABLE:
I authorize WEBVISIONS / ASIANFRONTIERS
(a subsisidary of Webvisions) to debit
my credit card as a (monthly / quarterly /
semi-annual / yearly)* (recurring / one-time)*
charge for their services rendered at agreed
published prices.
Should I dispute a charge through my credit
provider this will constitute a breach of
contract. It will also result in immediate
deactivation of all services rendered
by Webvisions or any of its subsidiaries.
* delete where applicable
I have included a photocopy of the credit card both front
and back and have signed the photocopy.
Card Holder
Signature: ______________________________________
Date: ________________
INSTRUCTIONS
Please print, sign, date, and fax to WEBVISIONS /
ASIANFRONTIERS NETWORK SERVICES
at one of the following offices.
(65)-6773-9389 - Singapore
(61)-2-9281-7642 - Australia
(91)-22-2852-3400 - India
(03)-8319-5385 - Malaysia
(852)-3113-0709 - Hong Kong
(86)-21-63519845 - China
(01)-508-3003065 - USA