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CC Auth Form

Thank you for the authorization. We will process this request promptly. Please let me know if you have any other questions!

Uploaded by

Binh Nguyen
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798 views1 page

CC Auth Form

Thank you for the authorization. We will process this request promptly. Please let me know if you have any other questions!

Uploaded by

Binh Nguyen
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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VULTR.

com Credit Card Authorization Form


Vultr.com Account: [email protected]
14 Cliffwood Ave Suite 300 NGUYEN QUANG BINH
Matawan, NJ 07747 Thn 10 x hi xun
Phone: 973-849-0529 | Fax: 732-566-1268 H NI VN

Please attach the following information to your open support ticket for verification using the customer portal at
https://my.vultr.com/support/

1. A copy of your government issued photo ID - driver's license, passport, etc. (Please use a camera phone or digital camera to
take a photograph)
2. A partial image of the card used to fund the account to ensure the provided identity matches the name printed on the card. For
your protection, please cover all but the last 4 digits of the card. (Please use a camera phone or digital camera to take a
photograph)
3. This completed form.

I authorize vultr.com to bill my credit card account for subscriptions and bandwidth overage incurred under my account
[email protected].

Account Information:
NGUYEN QUANG BINH
Thn 10 x hi xun
H NI , VN

Credit Card Type (circle one): Amex Discover Visa Mastercard

Credit Card: 4221 0930 0090 0878


Last 4 Digits 0878 Exp. Date (mm/yy) 10/21

Owner of Account: NGUYEN QUANG BINH


First Name BINH Family Names(s) NGUYEN QUANG

Address: DOI 10a HAI XUAN


Street Hi Xun City MONG CAI

State/Province QUANG NINH Zip/Postal Code 260000 Country/Region VIET NAM

Phone: +84988943682 Fax: E-mail: [email protected]

Signature of Cardholder: Bnh Date: March 2, 2017

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