Change of Payment Information Form
Validation Section
Username:
2 to 8 characters,
lowercase
Password:
6 to 16 characters, mixed case
Updated
Payment Information
For monthly billing, please enter your credit card number. (Only cash & check payments MUST be paid in 3 month increments. Mail form and payment to:
HyperSurf Internet Services Inc.
37481 Maple Street, Suite I
Fremont, CA 94536
)
Payment Options:
VISA
Mastercard
AMEX
Select One
Check
Cash
Billing Period:
Monthly
Semi-Annually
Annually
Credit Card Number:
Exp. Date (mm/yy):
AMEX CID #:
located above card #
Printed Name:
CC Billing Address:
City:
State:
Zip/Postal Code:
Country Code:
(2 letter)
Phone of CC Holder:
Submit
Please check the above information. Press
"SUBMIT"
to submit your information for processing. Press
"RESET"
to clear your information.