Formato de Cargo Automatico ....

Español Ingles

To all of our clientes: you can now make your payments
via credit card by filling the form bellow. once filled all you have to do is print it and send it to Sigmanet at:

Sigmanet, San Pedro Sula, in front of Ind. Panavision
Phone: 557-6971 557-6974 Fax:557-6518
Tegucigalpa: Centro comercial la Epoca. BLVD Morazan
(TEG) tel: 221-4877 fax: 221-48666

I, AUTHORIZE TO SIGMANET TO COLLECT FROM MY CREDIT CARD (SPECIFIED BELLOW), THE QUANTITY OF US$ , CORRESPONDING TO MY MONTHLY PAYMENT FOR INTERNET SERVICE.

CREDIT CARD NUMBER:
EXPIRING DATE: ..........
NAME ON CARD: ..........
ADDRESS: ...................
PHONE NUMBER: .........
E-Mail:.........................

CREDIT CARD HOLDER SIGNATURE: _______________

NOTE: TO PRINT THIS FORM CLICK ON THE PRINT ICON ON THE TOP OF YOUR BROWSER.