Advanced Worldweb Design (AWD)          Credit Card Authorization 

5415 Lake Howell Road, Suite 204 WinterPark Fl. 32792

Phone 407-673-9331 Fax 877-207-5458

Your Name ___________________  Company Name:_________________

Website Name: _______________ Address: _______________________

City: _________________________ State: __________ Zip: ___________

Phone Number _________ Fax Number: __________ Cell Phone#: _______

E-Mail: ______________

I authorize Advanced Worldweb Design to charge my:

____Visa ____Master Card

Amount ___________

Card # _____________________________ Exp. date ____________

The 3 digit number in the back of the card, CVS#_________________

Name (as it appears on card) ________________________________

Address__________________ City ________________ St__________

Zip_____________

Hosting fees will auto re-bill to your card on file quarterly, or yearly depending on your hosting plan.  To cancel you must call 30 days prior to you re-bill date 407-673-9331 x5, or fax letter to 877-207-5458

I understand that fees are non-refundable

I agree with the Terms and Conditions

 Signed: _______________________ Date: _____________________

Thank you. We look forward to working with you.