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Please take a moment and print this out.
It will be needed along with a copy of your credit card
faxed over to cybertime
- FAX (513)326-5380
You will now need to Print this page, fill it out, and fax it and a copy of the front and back of BOTH the credit card used for this purchase, AND a Valid Driver's Lience or State or Country issued form of identification. This is a requirement from our merchant bank and we appreciate your compliance. Our fax number is 513-326-5380. Also include the statement:


I, _________________________________ (card owner's name)
authorize this payment of
$_______________________________
on my credit card.

The billing address of the credit card is the following

______________________________________________________

______________________________________________________

______________________________________________________

______________________________________________________

Please select a License Type:

New License Purchase WAS NOW
1 - 10 PC License $599 $400
11 - 25 PC License $899 $650
26 - 50 PC License $1299 $950
51 - 100 PC License $1999 $1500
Upgrade License WAS NOW
1-10 to 11-25 PC License $300 $250
1-10 to 26-50 PC License $700 $550
1-10 to 51-100 PC License $1400 $1100
11-25 to 26-50 PC License $400 $300
11-25 to 51-100 PC License $1100 $850
26-50 to 51-100 PC License $700 $550



_____________________________________________________
signature of cardholder
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