AUTHORIZATION TO CHARGE CREDIT CARD

Client ID:
Company Name:
Email Address:
Name On Credit Card:
Credit Provider:
Credit Card Number:
Expiration Date:
I authorize VGS CORPORATION to debit my credit card as a monthly recurring 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 and will result in immediate deactivation of my virtual server.

I have included a photocopy of the credit card both front and back and have signed the photocopy. 

 
Signature ______________________________________   Date ________________


INSTRUCTIONS
Please print, sign, date, and fax to SUPERHOST.COM, VGS CORPORATION. (734-629-0335). Mail original to SUPERHOST.COM at address included below.