AUTHORIZATION TO CHARGE CREDIT CARD

         Customer ID:
        Company Name: 
        Name On Card: 
     Credit Provider: 
  Credit Card Number: 
     Expiration Date: 
I authorize Blue Reef Consulting, Inc. to debit my credit card as a monthly recurring charge for their services rendered at agreed published prices. Should I dispute a charge through my credit provider this will constitute a breach of contract and will result in immediate deactivation of my virtual server.

I have included a photocopy of the credit card both front and back and have signed the photocopy.
Signature ______________________________________   Date ________________






INSTRUCTIONS
Please print, sign, date, and fax to Blue Reef Consulting, Inc. (305-274-9593). Mail original to Blue Reef Consulting, Inc. at address included below.