Below you will find our credit card authorization form. Please print this form, complete, and sign it.
Then fax the completed form and a legible copy of the back of the credit card to
1-815-301-8737
Thank you for choosing MaxMind LLC.
MaxMind LLC - Credit Card Authorization Form
- Product _________________________________________
- Card Number _____________________________________
- Expiration Date _________________________________
- Cardholder name _________________________________
- Cardholder billing address ______________________
_____________________________________________________
_____________________________________________________
- I authorize MaxMind LLC to charge $________ USD to the credit card listed above
- Card holder signature: (Must be in handwriting)
____________________________________________________
Today's Date _______________________________________
- Also remember to send us a visible copy of the credit card (back side), including signature panel.
The cardholder agrees that MaxMind LLC will bill the subscriber's credit card.
Thank you for your cooperation & your business.
MaxMind LLC
221 Mass Ave
Boston, MA 02115
Fax: 1-815-301-8737