| Credit
Card Information |
|
| Hunter Point Online accepts payment by
Visa, American
Express, MasterCard, DC Card, JCB, Diners Club, GC Card, Million Card,
. However, we appreciate that some people may not wish to provide
credit card information over the Internet. |
|
| Personal Information |
| Title: Mr. Ms. |
Account holder's name. |
| Given Names: |
|
| Last Name: |
|
| Contact E-mail Address: |
|
| Day Phone: |
|
| Night Phone: |
|
| Mother's Maiden Name: |
|
| Your Date of Birth: |
e.g. Dec. 25,
1969 |
|
| Credit Card Information |
| Card Holder's name as it
appears on the card if different from Account holder. |
| Given Names: |
|
| Last Name: |
|
| Credit Card Company: |
|
| Card Number: |
|
| Expiration Date: |
Month Year |
|
| Payment Type: |
|
|
Note: All price listed
include 5% tax. |
| Account Type: |
|
| I authorize Hunter Point Online
to make charges to my credit card for the purpose of paying my Internet account fees and
any other fees owed by me to Hunter Point Online. I will send a formal cancellation when I
wish to discontinue my service and/or payment by credit card. |
|
| Agreement: I understand that I am liable for the
full amount of any costs incurred under my UserID in using this service, and that all
Terms and Conditions of the Hunter Point Online Service
Agreement SIGNATURE (for fax applications only, ignore if submitting online):
_______________________________ DATE:____/____/____
|
|
|
Copyright Hunter Point Online.
Last revised: Feb. 27, 2008. |