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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 _________________, 2011.
_______________________________________________
CREDIT
Address Numbers: _________________Zip: __________ 3 Digit
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 _________________, 2011
X______________________________________________________