Acknowledgment
of Receipt and Execution of Agreement
VPS Hosting is an MDM Enterprise Company
The
undersigned acknowledges that they have received, read, accepted
and agreed to the VPS Hosting Simple Host Web Server Agreement
dated October 22, 2005, and incorporated by this reference.
| Company
Name: |
_____________________________________________________________ |
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| Signature: |
___________________________ |
| |
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| By: |
___________________________ |
| |
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| Title: |
___________________________ |
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The
understand is represented as the credit card holder for payment
on this hosting account and also bears a financial responsibility
on a recurring bases for all charges posted to the customers
account in question. Charges to the customers account will be
automatically settled to the below credit card and is authorized
on a recurring basis for the life of the customers account with
VPS Hosting and beyond the life to the extent of settling
all balances due.
As
the card holder, I authorize VPS Hosting, an MDM Enterprise brand, to debit my credit card as a monthly recurring
charge for their services rendered at agreed published prices.
Should I dispute a charge through my credit provider this will
constitute a breach of contract and will result in immediate
deactivation of my virtual server.
| Company
Name: |
____________________________________________ |
| |
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| E-Mail
Address: |
____________________________________________ |
| |
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| Name
on Card: |
____________________________________________ |
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| Issuing
Bank Name: |
____________________________________________ |
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| Credit
Card Number: |
____________________________________________ |
| |
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| Expiration
Date: |
| Month/Year: |
_______
/_______ |
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| |
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| Cardholder
Signature: |
____________________________________________ |
| |
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| Date
Signed |
____________________________________________ |
|
PLEASE
NOTE: On your Bank Statements, all charges from VPS Hosting,
will appear as MDWA Solutions.
INSTRUCTIONS
After you have reviewed the Virtual Server Agreement, please
print, sign, date, and fax only this page to VPS Hosting
at the following fax number listed below, or mail original to
the address listed below. You may also scan in the completed
document and e-mail it as an attachment to myhelpdesk /@/ vpshosting.net (please remove the @ and forward slashes from the previous e-mail address). For security purposes include a legible photocopy of the front and back of the credit card as well as a government issued photo identification. This step is to cust down on internet credit card fraud.
| Nevada,
United States: |
480-461-9312 |
VPS Hosting
6543 East Omega Street
Mesa, Arizona 85215
USA |