In order for us to schedule a support session, we must be able to accept and bill your credit card. However, the card cannot be billed until service is finished and the final amount is known.

Please fill out the form below, agree to the terms and conditions, and sign using your digital signature. All information kept on file is strictly confidential.

Required*

Type of Support Requested  * On-Site Support Visit  Remote Support  

 

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Full Name (as appears on card)  *

 

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Address (c.c. billing address)  *

 

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City  *

 

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State  *

 

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Zip  *

 

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Phone Number  *

 

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Email Address  *

 

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Website

Credit Card Type  * Visa  Mastercard  Discover 

 

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Credit Card Number  *

 

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Security Code  *

 

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Agree to Billing Agreement?  *

 I hereby authorize New Vision Computers to charge the indicated credit card one time only for the services indicated above. I am NOT authorizing New Vison Computers to set up my account in a recurring billing system - rather I prefer to pay by check or money order for all future invoices. I understand that if I wish New Vision Computers to charge any balances to my credit card in the future, I will need to submit another authorization form at that time and that my information is not stored online, and is completely secure.

 

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