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CCORDER.FRM
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1992-05-31
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2KB
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51 lines
Sunrise Door/Game Software Registration Form
Credit Card Payment Supplemental Form
(MUST BE ATTACHED TO REGULAR REGISTRATION FORM)
[ ] VISA [ ] MasterCard [ ] Discover [ ] JCB
[ ] American Express [ ] CarteBlanche [ ] Diner's Club [ ] Optima
Card Number: _____ _____ _____ _____ Exp. Date: _______
**** PLEASE READ: The name MUST be the name, as it appears on the Credit Card.
The Address info MUST be the address the Credit Card company
uses to mail you your monthly bill. You MUST include a home
telephone number AND a work telephone number.
Name: _______________________________________________________
Address: ____________________________________________________
City: _______________________________________________________
State / Country: ____________________________________________
Zip / Postal Code: __________________________________________
Home Phone (xxx-xxx-xxxx):___________________________________
Work Phone (xxx-xxx-xxxx):___________________________________
NOTE: Everything MUST be filled in and the form signed! NO EXCEPTIONS!
Use of false information is a Federal crime and will be prosecuted to
the full extent of the law, regardless of the size of the transaction.
You will be responsible for any fees charged back to me due to any
mis-use of the card (similar to a bounced check.. approx. $25.00)!!!!
* A surcharge of 5% will be added to the total registration for all
Credit Card orders!
** ALL Credit Card charges will appear on your monthly Credit Card bill
as having originated from "Sunrise Door Software". Be sure to make
note of this !!!!!
Signature: _________________________________________________
05/31/92