Please complete the following form with your credit card information and fax or send via US Mail to:
Billing Manager Wireless Services Corporation 12301 NE 10th Place, Suite 301 Bellevue, WA 98005 Fax: 425-641-9080
If you have additional questions, please contact our sales department at 1-425-641-3020 Monday through Friday from 8:00AM-5:00PM PST or send us an email at accounting@AirNote.net.
Please check one of the following: VISA____________ MASTERCARD____________ CARD NUMBER: _______________________________________ EXP DATE: _____/______ CARDHOLDER NAME: ___________________________________ CARDHOLDER ADDRESS: ________________________________ CITY: ____________________________ STATE: _________ ZIP: ___________________ PHONE NUMBER: ________________________________________________________________ COMPANY NAME (If Applicable): ________________________________________________ 1) AIRNOTE ADDRESS: __________________________________________________________ Include additional AirNote addresses below if your paying for more than one account: 2) AIRNOTE ADDRESS: __________________________________________________________ 3) AIRNOTE ADDRESS: __________________________________________________________
I authorize Wireless Services Corporation to charge the credit card above for fees associated with the AirNote wireless e-mail service. I authorize an initial charge upon activation for the number of full months between the activation date and the first day of the next quarter (i.e. January 1, April 1, July 1, and October 1). Thereafter, I authorize a quarterly charge, on the first day of the quarter, for three months pre-paid service at a monthly price of $7.00.
CARDHOLDER SIGNATURE: _____________________________