Payment Advice Form

Name:
Date:
Address:
Domain name:
Payment method:	Cheque Money Order Credit Card

Payment by Cheque or Money Order

I have enclosed a cheque for $___________

Please make cheques payable to Infotech Hosting and write your domain name on the back of your cheque. Mail your payment, together with this form to the address on the bottom of this form.

Payment by Credit Card

Type of card:	Bankcard MasterCard VISA American Express JCB
Name on card:
Card number:
CVV* Code (compulsory)
Expiry date:
Cardholder signature:

* Your CVV code is the last 3 digits of the number printed on the back of your credit card (or the 4 digits printed on the front of your Amex card).

Please tick one box:

Each month, please charge my monthly web hosting fees to the credit card I have indicated above until I cancel my web hosting account, which I may do at any time by notifying Infotech Hosting in writing. I understand that Infotech Hosting will send an invoice to me via email seven days before any charge is made to my card, so that I have the opportunity to check/dispute the charges before they are actually incurred.

Please make a one-off charge to the credit card I have indicated above for the following amount: $___________

Please mail this form to:

Infotech Hosting
PO BOX 286
Bond University QLD 4229