Authorization to Charge Credit Card

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.

 Blue Reef Consulting, Inc.

  7785 SW 86 Street - Suite 417

  Miami, FL  33143

  USA

  

  fax: 305-274-9593

  phone: 305-274-8393

  email: service@bluereef.net