Credit Card Payment Form

Mail or FAX to:
Don Best Sports
3120 S. Durango Drive #305
Las Vegas, NV 89117
Tel: (800) DON-BEST
FAX: (702) 579-7955

Please check one of the following:

Auto Pay
I hereby authorize Don Best Sports to charge $___________________ each month to my credit card listed below for computerized line service. The monthly charge will be automatically billed to the credit card on the 25th day of each month that the service or services are active until written notice is provided to Don Best Sports to cancel service. Notice of cancellation must be in writing.
One Time Charge
I hereby authorize Don Best Sports to charge $___________________ to my credit card listed below for computerized line service for the month(s) of: ______________________________________ .

For all credit card payments, the following information must be filled out and either mailed or faxed back to Don Best Sports.

*** NEW CUSTOMER ***

DON BEST ACCOUNT NUMBER: __________________________

*** Requested Username: __________________________ Password: ____________________________

Don Best Account Name: _________________________________________________________________

Customer Phone Number: (____) ___________________________________________________________

Cardholder Name: _______________________________________________________________________

Cardholder Address: _____________________________________________________________________

City: ________________________ State: _____________________ Zip: __________________________

Cardholder Phone Number: (____) __________________________________________________________

***** COPY OF CREDIT CARD (FRONT & BACK) REQUIRED FOR PROCESSING *****

VISA MC AMEX (Circle One)

Credit Card Number: _______________________________________ EXP.: _________ CVV #: _________

Cardholder Signature: ____________________________________________________________________

Approval #: ____________________

Comments: _____________________________________________________________________