Cariaccess Communications Ltd.
Palm Plaza
tel.
246 430 7435
Wildey, Barbados.
fax. 246 431
0170
P.O.Box 126, Kingstown tel.
784 457 4755
Villa, St Vincent fax.
784 458 4385
P.O.Box 946, Castries tel. 758 451 3355
John Compton Highway, St Lucia fax. 758 453 1331
www.cariaccess.com
CREDIT
CARD AUTHORISATION FORM
I
hereby authorize Cariaccess Communications Ltd. to charge my credit or debit
card for services rendered. (please sign below and fax in to us)
Cardholder
Details:
Name
as it exactly appears on the card:_____________________________
Card
number: ________ _________ _________ _________
4 digits 4 digits 4 digits 4 digits
Expiry
date: _____/______
Amount
to be charged: $___________ (please
check currency below)
US$
[ ] EC$
[ ] BDS$
[ ]
Comments:
_____________________________________________________________
_____________________________________________________________
Signature:
____________________ Date: _____/
________/ _________