VoiceGate Credit Card Authorization Form

 

 
Name: _________________________________________________________________________

                       (First  Name)                                                            ( Last Name)

 

Company Name: ________________________________________________________________________

 

Address: _______________________________________________________________________________

 

Phone#: ______________________________________        Fax#: ________________________________

 

As part of this agreement, ”Customer”/Cardholder authorizes VoiceGate Corporation to charge for said product and / or service on the credit card information indicated below:


Credit Card: (Please Circle)                 Visa                        MasterCard                            American Express

 

Credit Card Number: ___________________________________________    Expiry Date: _____________

 

Cardholder Name: _______________________________________________________________________

 

I,________________________, have been  authorized to make purchases for “Customer” and am an authorized signatory on  this credit “card”.

___________________________________
         (Authorized Signature)

This “Card” authorization will apply and be legally binding for any future orders (written or verbal) placed by “Customer” via phone, fax, e-mail, or any other means.  In addition to the card signatory, the following individuals may place orders on “Customer’s behalf”:

_____________________      ______________________      _____________________
           (Name)                                    (Name)                                   (Name)

_____________________      ______________________      _____________________
         (Signature)                             (Signature)                               (Signature)

and I understand all charges will be applied to the aforementioned credit card.

Should “Customer” choose to revoke such “Card” authorization, he/she must do so in writing, with said revocation taking place within ten business days of receipt of said notification.

Written notification is to be sent to:
VoiceGate Corporation, 130 Queens Quay East, Suite 110 — West Tower, Toronto, Ontario  M5A 0P6

Signature:________________________________           Date: ________________________


To send a fax mail dial: 905-508-0355, enter “*2165”, wait for the tone and  then press the start key on your fax machine or; scan and email to lcartier@voicegatecorp.com.

A VoiceGate technician will contact you to set up a call-back time once your information has been processed.

Thank you for your patronage.  VoiceGate is committed to providing the highest quality service available in the international market place.

Prepaid technical support hours are from Monday to Friday 9am – 5pm EST.  Unused Pre-paid support is valid for 6 months from the date the credit card was processed.