HoloNet | Support | Update Billing Information

HoloNet
A service of IAT, Inc. | www.holonet.net

Update Billing Information - Fax/Mail Form

Use this form to update the billing information for your account. Our Billing Department fax number is: (510) 704-4545

For instructions, see: http://www.holonet.net/holonet/support/updatebillinfo.shtml#auth

Update Billing Information
Billing Plan - check the appropriate option ------------ Basic (___) 30/30 (___) No change (___) Renewal Option - check the appropriate option -------------- Monthly (___) Yearly (___) No change (___) Billing Method - check the appropriate option and provide the required info -------------- (___) Credit Card Card Number: _______________________________ Exp. Date: _________ Cardholder Name: _________________________________________________ Card Type: Visa (___) MasterCard (___) Amex (___) (___) Deposit -- Identification (ID) information is required for Deposit Billing ID Type (e.g., driver's license): ________________________________ ID Number: _______________________________________________________ State/Country: __________________________ Exp. Date: __________ (___) Purchase Order (P.O) P.O. Number: _____________________________________________________ (___) No Change Billing Address --------------- Business Name or Street Address 1: _______________________________________________________ Street Address 2: _______________________________________________________ City: ___________________________________________ State: _______________ Country: __________________________________ Postal Code/Zip: ___________ ACCOUNT NAME: ________________________________ SIGNED: ________________________________ NAME & TITLE: ________________________________ Form MUST be signed by either the account Administrative Contact, Billing Contact or a Company Officer

Update Billing Information


Billing Plan - check the appropriate option
------------

   Basic (___)    30/30 (___)   No change (___)


Renewal Option - check the appropriate option
--------------

   Monthly (___)  Yearly (___)  No change (___)


Billing Method - check the appropriate option and provide the required info
--------------

   (___)  Credit Card    
     
          Card Number: _______________________________  Exp. Date: _________ 

	  Cardholder Name: _________________________________________________

	  Card Type:  Visa (___)  MasterCard (___)  Amex (___)  


   (___)  Deposit 

	  -- Identification (ID) information is required for Deposit Billing

	  ID Type (e.g., driver's license): ________________________________ 

	  ID Number: _______________________________________________________  
	  
	  State/Country: __________________________    Exp. Date: __________ 


   (___)  Purchase Order (P.O)

	  P.O. Number: _____________________________________________________


   (___)  No Change


Billing Address
---------------

   Business Name or
   Street Address 1: _______________________________________________________

   Street Address 2: _______________________________________________________

   City: ___________________________________________  State: _______________

   Country: __________________________________  Postal Code/Zip: ___________



            ACCOUNT NAME: ________________________________


                  SIGNED: ________________________________


            NAME & TITLE: ________________________________


      Form MUST be signed by either the account Administrative Contact,
                     Billing Contact or a Company Officer