Company Name:Credit Card Number:Credit Card Type:—Please choose an option—American ExpressDiscoverMastercardVisaCredit Card Expiration DateCVV2 Code (Card Verification Code)*Name on CardBilling AddressAuthorized Electronic Signature (First and Last Name)Your Email AddressI affirm that I am an authorized user of the above listed card and accept charges for order(s) charged to my account in accordance with the Triad Telecom Terms of Service. I understand that if I make changes to my service(s) that affect my monthly rate, my credit card will be billed according to the new rate. Acceptable new and change orders may be submitted to Triad Telecom via signed documentation, electronic confirmation (both email and fax), and recorded verbal confirmation. I understand that recurring services will be billed as recurring charges to the above card and understand that these charges are non-disputable. Δ
