FastAr Internet Service
Customer Authorization Form
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AUTHORIZATION TO CHARGE A CREDIT CARD (Fax: 888.823.4976)
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If this is your first time submitting this authorization form for this credit card you must provide a copy of the credit card (front & back) and a copy of a photo ID.
Scanned and faxed copies are both acceptable. Please fax this to the number above or email it to billing@fastar.net. No exceptions! Once this information is on file, you can just submit a signed authorization form for future payment requests.
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ALL INFORMATION MUST BE FULLY ENTERED FOR US TO PROCESS YOUR PAYMENT REQUEST.
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Login :_______

Name on Card:______________________

Billing Address:______________________________

City,State,Zip :______________________________

Phone Number   :______________________________

Type of Card   :   Visa    -     Mastercard     (circle one)

Card Number    :___________________________

Exp. Date      :____________

Amount to Charge: $___________________


  I authorize FastAr ISP to charge my Credit Card as the method of payment for my services through their company.
  I realize that this payment is non-refundable and have read and agreed to FastAr's billing policy.


Signature ___________________________________ Date ___________________



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