DSL vaughns.com Internet Service DSL
*PO Box 4033 * Independence, MO 64051* 816-399-0925 (DSL Order Form)
Email
Address: __________________Password: __________________Starting Date:
_____________
Your Name: ________________________________________________
Your Address: _______________________City ________________State _________ZIP________
Home Phone Number: _______________________________Cell: _______________________________
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BANK DRAFT AUTHORIZATION
Bank Name:
__________________________________
Routing Number: ______________________________
Account Number: ______________________________
the
undersigned hereby authorizes Vaughn's Computer Central
to draft
my checking account in the amount of
o$29.95(T1
Download Speed) o$39.95(Super
cool 3Mb) o$49.95
(SuperfastV 6Mb)
Every month for Internet services
rendered.
This authorization shall remain in effect until such
time as the undersigned
shall cancel service.
Signed this
____________ day of _________________, 2013.
_______________________________________________
CREDIT CARD AUTHORIZATION
Address
Numbers: _________________Zip: __________ 3 Digit CRC Code:
______
credit card #:
_________-___________-___________-__________ expiration date:
__________
the undersigned hereby authorizes Vaughn's Computer
Central to charge my credit card in the amount of:
o$29.95(T1
Download Speed) o$39.95(Super
cool 3Mb) o$49.95
(SuperfastV 6Mb)
Every month for Internet services rendered. This
authorization shall remain in effect until such time as the
undersigned
shall cancel service.
Signed this ____________
day of _________________, 2013
X______________________________________________________