Authorization
I hereby authorize THE
Competitive Internet Access to charge the amount
shown above to the
card specified above. In addition, if I have
initialed the automatic payment section above, I
authorize
THE Competitive Internet Access to charge my card
each month/quarter/year for all fees due that
period for the services I have subscribed to,
until I notify them 15 days prior to the next
billing date
in writing. I understand that the fees due will
include the regular monthly/quarterly/yearly fees
for
that period. I agree to pay the above credit card
charges in accordance with the Card Issuer
Agreement. I understand that THE Competitive
Internet Access will apply a chargeback fee to
my account ($45.00 as of the time this is written),
if I initialize a chargeback with my credit card
issuer, to reverse payment without permission of
THE Competitive Internet Access of any of the
charges authorized on this form, and I agree to
pay this fee if this occurs.
Cardholder Signature:_________________________________________Date:_________________
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