Print, Complete and mail to

WAM Computers
211 N. State, PO Box 261
Litchfield, IL 62056




Credit Card Number: ______________________________ EXP: ____________

CVV2 Number (located on the reverse side of your card in the signature block) _________

Card Type: ______ Visa ______ Master Card ______ Discover

Name on card:______________________________________________________

Internet Account Number or Login Name:_________________________


I hereby authorize WAM Computers to initiate debit entries to my credit card as indicated above and to credit WAM Computers the amount of $14.95 monthly for Internet access.

This authorization is to remain in full force and effect until WAM Computers has received written notification from me of its termination in such time and in such manner as to afford WAM Computers a reasonable opportunity to act upon it. My Internet service will continue to the end of the month that WAM Computers received notification.


Signed: _____________________________________ Date: _______________