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One time credit card payment
Not for use to fund SIP TRUNK accounts, only use this form if you received an invoice

 
     
 

Type of credit card (check one) VISA   MASTERCARD   AMEX
Card Number:
Expiration Date: 
CVV2 Code: 
Name on the card
Billing Address
City
State
Billing ZIP Code
Payment amount $
Invoice or reference number
Notes

I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form. 

Authorized Signature:  Date: