AUTHORIZATION AGREEMENT FOR PRE-ARRANGED PAYMENTS-CREDIT CARD

INDIVIDUAL OR COMPANY NAME_____________________________________

I (we) hereby authorize BRIGHT.NET-BRT, to charge my (our) Credit Card indicated below.

NAME (as shown on credit card)_______________________________________________________

BILLING ADDRESS _________________________________________________________________

CITY___________________________________________ STATE___________ ZIP______________

CREDIT CARD NUMBER ____________________________________________________________

EXPIRATION DATE ______________ CREDIT CARD _____________________________________

This authority is to remain in full force and effect until BRIGHT.NET-BRT has received written notification from me (or either of us) of its termination in such time and in such manner as to afford BRIGHT.NET-BRT a reasonable opportunity to act on it. After account has been charged, a customer has the right to have the amount of an erroneous debit immediately credited to his account by BRIGHT.NET-BRT, provided I (we) send written notice of such debit entry in error to BRIGHT.NET-BRT within 15 days following issuance of the account statement or 45 days after posting, whichever occurs first.

(PLEASE PRINT)

NAME___________________________________________________________

SS NUMBER______-____-________

SIGNATURE______________________________________________________

NAME___________________________________________________________

SS NUMBER______-____-________

SIGNATURE_______________________________________________________

(On a joint account, both husband and wife must sign)

DATE _____ / _____ / _____

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