CS-Net, LLC
dba The SUM Group
107 Vine Hill School Road
Scotts Valley, CA  95066
USA
info@sum.com
+1-831-439-0870 fax +1-831-439-0871

CREDIT CARD AUTHORIZATION FORM		

Please print, fill out this form and fax or mail to:

Fax: +1-831-439-0871
Mail: 107 Vine Hill School Road, Scotts Valley, CA 95066 USA

Date:  ____________________________	Name: _____________________________
	
Company Name:  __________________________________________________________

Email address: _____________________________  

Alternate email address: _______________________

Telephone: ______________________________     

Alternate telephone: ___________________________

Fax number:  ____________________________

I / we authorize CS-Net, LLC / dba The SUM Group to charge my (please 
choose):

____ American Express								
____ Visa
____ MasterCard
____ Discover		

Credit card #: _________________________________________    
Expiration date -  Month: ____  Year: ______

You must attach a copy of credit card (front & back) and photo 
identification

The total purchase amount of $ ______________________ us dollars
 
As payment for your order / estimate number _____________ from CS-Net, LLC 
dba The SUM Group.

________________________________
Signature Acceptance

Address information - please include complete address: 
 
Company name - if any, name, street address, city, state/province, postal 
code and country

Credit Card Billing Address:  		Ship to Address:

_______________________________       	__________________________________

_______________________________		__________________________________

_______________________________		__________________________________

_______________________________		__________________________________

_______________________________		__________________________________
 

 
 
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