Formato de Cargo Automatico
             Espaņol
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Dear Globalnet Subscriber:
To avoid payments in the bank, please fill out this form and FAX  it at 566-0455.( Use your keyboard to type please) If you are paying for installation fees, please click the one time charge only box. If you want to have your monthly rate charged to this credit card, please click the recurring charges box.


NAME AUTHORIZE GLOBALNET TO CHARGE  MY CREDIT CARD THE QUANTITY OF US$ , CORRESPONDING TO:
One Time Charge       Monthly Charge

 
   CREDIT CARD NUMBER:
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  EXPIRING DATE:
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   NAME ON CARD:
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   ADDRESS:
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   PHONE NUMBER:
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   E-Mail:

 

              CREDIT CARD HOLDER SIGNATURE:_______________________

             * NOTE: TO PRINT THIS FORM CLICK ON THE "Print"