vaughns.com
Internet ServiceVaughns.com Internet Service
*6261 N Oak Trafficway* Gladstone, MO 64118 * 816-455-1600
User Name: _______________Password: __________________Starting Date: _________________
Name: ________________________________________________
Customer Address: _______________________City ________________State _________ZIP ________
Customer Phone Number: _______________________________
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BANK DRAFT AUTHORIZATION
Social Security Number: ______________________________
Bank Name: ______________________________
Account Number: ______________________________
The undersigned hereby authorizes Vaughn's Computer Central
to draft my checking account in the amount of
$14.95 every month for Internet services rendered.
This authorization shall remain in effect until such time as the undersigned
shall cancel service with 30 days prior written notice.
Signed this ____________ day of _________________, 2013.
X_______________________________________________
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CREDIT CARD AUTHORIZATION
Name: _______________________________________________
Address: ____________________________ City:____________________
State: ________ Zip:__________
credit card #: ________________________expiration date:___________
The undersigned hereby authorizes Vaughn's Computer Central
to charge my credit card in the amount of
$14.95 every month for Internet services rendered.
This authorization shall remain in effect until such time as the undersigned
shall cancel service with 30 days prior written notice.
Signed this ____________ day of _________________, 2013.
X______________________________________________________