To apply for the Credit card (VISA / MasterCard) payment service, please fill in the Credit
Card Payment Authorization form below and mail / fax back to us with a photocopy of your
credit card.
CREDIT CARD PAYMENT AUTHORIZATION
I hereby authorize Cyber Express Communication Ltd. to charge my credit card
Family Name:
account above every month on the payment due date for all services provided by
Cyber Express Communication Ltd. to the Applicant herein. This authorization shall
Given Name:
have effect until further notice.
To terminate this authorization, please submit a written notice to Cyber Express
User Login ID:
Communication Ltd.
Card Type:
VISA MasterCard
Card Number:
Card Expiry Date :
The provision of personal data in the application process for Cyber Express services is voluntary.
Failure to provide the data requested may mean that Cyber Express is unable to supply the mm yy
relevant services. Personal Data collected will be used in matters relating to the operations,
Cardholder`s Name :
including billing, account maintenance, and marketing activities of Cyber Express Communi-
cation Ltd., and may be disclosed to third party organizations which assist in the Company's
operations, including billing, customer service and marketing.Data access and correction re-
quests may be addressed to the Customer Service Manager, Cyber Express Communication
Authorized Signature of Cardholder :
Ltd., Room 703A Perfect Ind. Building, 31 Tai Yai St., Sanpokong, Kowloon, Hong Kong.
For enquiries please call Cyber Express Communication Ltd.
Tel: 2353-1445 Fax: 2353-1105
URL: http://www.cyberec.com Email: info@cyberec.com
Address: Room 3A, 7/F, Perfect Ind. Building, 31 Tai Yau St, Sanpokong, Kowloon, HK.