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Credit Card FAX FORM

 Please print this form
Then complete and return it to us

For credit card payments please print and fax the following form to our offices within 48 hours.

If fax is not availble please send by mail to:

The Software Group
P.O. Box 687
Moorpark, CA 93020

Credit card accounts will be setup within 24 hours.

Fax Numbers: 775-254-1480

The Software Group Charge Authorization


NAME: ___________________________________________________

ADDRESS: _________________________________ _______________

CITY:_________________________  STATE:____ ZIP:__________

CARD#:___________________________ EXP. DATE: ____________

Domain Name: __________________ 

Authorized (One Time / Monthly / Yearly) Charge $_________________
                                  (select one)

[  ] Charge Card     ( MC / VISA / Discover / AmExp )
                                          (select one)

I authorize The Software Group to deduct my normal monthly service as outlined in the order form for the above domain.

Card Holder

                       (if different than above)

Your credit card statement will show a charge from
The Software Group

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