HuntingMoon Domain Sales Credit Card Authorization Form

To prevent the unauthorized use of your credit card, HuntingMoon requires this authorization form to be completed.
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Print this form.
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Place credit card on box below and photocopy form.
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Authorize the charges to your credit card by signing below.
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Fax signed form to 415-464-9837. No cover sheet is required.

Place Credit Card Here

Copy of ID showing your signature
OR
Copy of back of credit card

Order #:

 ________________________

Domain(s):

 ________________________________________________

Total Amount:

 ________________________

Card Number:

 ________________________________________________
Date:

________________________
 

I agree to pay the total amount as entered above according to the card issuer agreement. I hereby authorize HuntingMoon (or its parent company Essociate Inc. d.b.a. IPalert) to charge the above credit card for this amount. I agree to be bound by HuntingMoon's Sales Policies and the Domain Name Purchase Agreement for this transaction.

 

Signature:

 ________________________________________________
 

Cardholder Name:

  

________________________________________________