LETTER OF AUTHORIZATION FORM
In order for VIP Online Technical Services LLC to accept and bill your credit / Debit card / ACH, please complete all fields below,sign, date and click on submit. All information sent is strictly confidential and VIP Online Technical Services LLC adheres to the highest standards of account data protection.
Full Name
*
First Name
Last Name
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Payment Mode
*
Visa Credit Card
Visa Debit Card
Master Credit Card.
Master Debit Card.
Discover Card.
E-Check/ACH.
Proof Of Identity
*
Driver’s license.
Amount to Charge
*
Date Of Birth
*
-
Month
-
Day
Year
Date
Rate our service
*
Fully Satisfactory
Less than Satisfactory
Poor
Recommendation
*
I will recommend it to others.
I will not recommend it to others.
Please Check the Appropriate Box
*
One Time Use: I hereby authorize VIP Online Technical Services LLC to charge the indicated credit / Debit card / ACH the amount indicated above. This is a one-time charge authorization. I am not authorizing VIP Online Technical Services LLC to setup my account within a recurring billing system. I am an authorized user of this credit / Debit card / ACH and that I will not dispute the payment with my credit card / Bank; so long as the transaction corresponds to the terms indicated in this form.
Note:
*
A THIRD-PARTY SERVICE Provider For Software Related Issues In Desktops Computers, Laptops Computers & Peripherals. We Provide Services Through Our Pool Of Trained Specialists And Experts Who are able to service Leading Technology Organizations Such As Microsoft, Dell, IBM, HP, HCL Etc. The Brand Names, Trademarks, Logos, Company Names Used In The Site Are Belong To Their Respective Owners. Brand Names, Trademarks, Logos, Company Names Used In The Site Are For Representation Purposes Only.
Signature
Clear
Submit
Should be Empty: