ANSWERFIRST TELECOMMUNICATIONS
PHONEFARE-ANSWERFIRST-LEWISVILLE TAS-ANSWERFIRST NORTH/SOUTH
205 E. Center St.
Duncanville, TX 75116
DEBIT / CREDIT CARD AGREEMENT
Customer Name:_______________________________________________
Address:____________________________________________________
City: _____________________ State: ______ Zip: ____
Account #: _______ Date___________________
I hereby authorize the Message Center, (Answerfirst or one of its subsidiaries) to charge all services incurred on the above noted account. Please select one:
On each billing cycle ___
or
This billing cycle only___
to my credit card, as follows:
VISA___ MASTERCARD____ AMEX_____
Name as it appears on the card: _________________________________________________
(Please print)
Account # on the card: _________________________________________________
Additional code: ________ Expiration Date: ______________
(On back of MC & VISA and front of the AMEX Credit Card)
Address on your credit card statement (if different from above): _________________________________________________
___________________________________________________________________
I understand that if my account becomes 2 billing cycles past due, this agreement serves as authorization to charge my credit card, bringing my account current.
__________________________________________________
Cardholder Signature (Authorization) Date signed
****Please print, sign and return via mail or fax. Our fax # is 214-739-9672
