Authorization Form

Best1Hosting
233 Memorial Dr
Bath, Pa USA 18014

 

Thank you for selecting Best1Hosting for your internet presence!

Below is our authorization form that you will need to print out and fax back to us. This form gives Best1Hosting authorization to bill your credit card for your hosting charges. This form MUST be completed in order for your new account to Be allowed to remain on our servers. If you have any questions please let us know: accounting@best1hosting.com .

 

Best1Hosting
233 Memorial Dr
Bath, Pa 18014 USA
Fax: (610) 837-7752

 

Domain Name: _________________________________

Today's Date: _________________________________

Hosting Plan: ______________________________

Plan Cost: _________________________________

Total Billing Charge: _________________________________(monthly/Yearly/quarterly)circle one.


Cardholder Name: _________________________________

Cardholder Billing Address: ______________________________

City State Zip Code: _________________________________

Country: _________________________________

Credit Card Number: _________________________________

Expiration Date: __________


Credit Card Type (circle one):

 Visa

 Master Card

 American Express

 Discover


Cardholder Telephone Number: ________________________________

E-mail address for billing issues: ________________________________


To authorize billing to the above credit card, please sign below:

X_____________________________________________(Cardholder Signature)

My signature states that I authorize Best1Hosting to charge webhosting fees to my credit card as specified above. These charges will cover a Monthly,Quarterly or 12-13 month period from the date above. This authorization is valid until revoked in writing.

**All cancellations must be received in writing by the 1st of each month. Acceptable forms of cancellations are regular mail, fax, or e-mail. Phone requests will not constitute acceptance of any cancellation.**

Credit card fraud will not be tolerated. We actively and aggressively fight all forms of credit card fraud.

All accounts are subject to the terms of our Acceptable Usage Policy, Service Agreement and Spam Policy.

1998-2000 BEST1HOSTING. E-mail us at: info@best1hosting.com with your questions and comments about our services. We appreciate your feedback on our site. "BEST1HOSTING" in partnership with Internet Services.