- Please enter the required information and print the form.
- Sign and date the bottom of the agreement.
- Using your smart phone take a photo of the signed form, along with the front and back copies of your credit card(s).
- Take a photo of a valid government issued photo ID.
- Send us the photos of the signed completed agreement, credit card(s) and a copy of your government issued photo ID in JPEG or PDF format to email@example.com.
To avoid processing delays, please ensure that the name, address, credit card number and signature on your submitted documents are clearly legible.
IMPORTANT: Please read the following carefully before signing and dating.
By submitting this signed and dated form, along with the additional information requested, I am authorizing and fully acknowledging that:
- I acknowledge that this account was registered using my personal information and all transactions were initiated and authorized personally, using the above credit card.
- I agree that all transactions made in my account will be paid in full.
- I agree that any and all uncollected purchases or delinquent accounts are subject to 3rd party credit reporting and collections.
- I am over 18 years of age.
- I have read and accepted the terms described in the Transaction Processing Agreement.