PURCHASE AGREEMENT FORM

ATTENTION: CIRRUS  ACCOUNTING DEPARTMENT

Toll Free US Fax Number: 1.800.880.6186
UK Fax Number: +44 207 990 8100
International customers please scan and send to ccprocessing@cirruscasino.com



I, ______________________________________________ <name as shown on the credit card>, of legal age,

resident of _____________________________________________________________________________ (address), and card holder of

(Please check one) _____Visa _____ MasterCard

Card number: ________________________________ and expiration date ____/____

Card number: ________________________________ and expiration date ____/____

Card number: ________________________________ and expiration date ____/____

Card number: ________________________________ and expiration date ____/____

do understood and hereby authorized the charges made to Emoney Processing Ltd.

I hereby declared that I am the legitimate owner of the above-mentioned credit card.

I acknowledge this purchase(s) and agree that all sales are final. I acknowledge that I have read the entire agreement and understand that I will be held fully responsible for its terms and charges and I agree not to chargeback as long as I receive the services that are defined within the terms of agreement.

For verification purposes, I have attached the copy of my driver|s license, back and front copy of the credit card used.

I also agree that any changes on my account information, I will be sending this form again together with the changes in my account.

I hereby acknowledge that all information I have provided are true.

 

SIGNATURE: _________________________________

Date: ________________________________________


FOR FUTURE PURCHASE using credit card(s) mentioned above:
(please choose one)

____ As the credit card holder, I also authorize Emoney Processing Ltd. to charge my credit card for future purchases verbally or electronically approved by me.

Authorization valid until _____/_____

Signature/Initials: ______________

____ I will send this form again. Emoney Processing Ltd. can ask again for any other purchases.