CREDIT CARD AUTHORIZATION FORM

*** This credit card authorization form helps us protect you, our valued customer, from credit card fraud. All information entered on this form will be kept strictly confidential. Failure to submit this form may result in account termination. ***

1. Print this form and fill in all required information. Sign the form to acknowledge your agreement to all of the terms and conditions specified.
2. Make photocopies of the front and back of your credit card. Sign the photocopies.
3. Make a photocopy of your driver's license or any other signed government issued photo identification.
4. Fax to 1-631-938-0546 OR scan and email to billing@etwebhosting.com OR mail to any of our mailing addresses.

Please PRINT clearly and legibly.

I hereby authorize ET Web Hosting to debit my above-mentioned credit card for all fees (including automatically recurring fees) for the services that I have purchased (or will purchase in future) from ET Web Hosting.

I understand and agree that should I dispute any credit card charge through my credit card issuer or credit provider, it will constitute a breach of contract as well as credit card fraud. I have included signed photocopies of the front and back of my credit card and valid signed picture identification as requested above. I understand that this information will be used for the purpose of verification of my credit card.

By signing below and submitting for payment, I acknowledge acceptance of the ET Web Hosting Terms Of Service (http://www.etwebhosting.com/terms/tos.html) and all additional policies located at http://www.etwebhosting.com/terms/. I specifically acknowledge and accept that any request for account cancellation must follow the account cancellation procedures specified in the Terms Of Service.

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