Web5star Payment Advice Form

Name:

  

Date:

  

Residential/Business Address:
(not PO Box)

    

   

Telephone number:

  

Invoice number:

  

Domain Names covered by this payment/authority:

    

Payment method:

     Cheque     Credit Card     PayPal

Payment by Cheque Order

I have enclosed a cheque for AU$___________

Please make Cheque/Money Order payable to QCMS and write your domain name or invoice number on the back of your cheque.  Please do not staple cheques.   Please mail your payment, together with this form to:

Five Star Web Hosting Services   -  Accounts Administration -  P.O. Box 948, Bribie Island QLD 4507 AUSTRALIA

Payment by Credit Card

Type of card:     MasterCard     VISA
Name on card:  
Card number:  
Three-digit CVV code* (compulsory):  
Expiry date:  
Cardholder signature:
 

* Your three-digit CVV code should be printed on the back of your card directly following your card number.

Please tick one box:

Make a one-off charge to the credit card I have indicated above for the following amount:  AU$___________
Each quarter / year (cross out the option that is NOT applicable), charge my web hosting fees to the credit card that I have indicated above until I cancel my web hosting account, which I may do at any time by notifying Qld. Computer Management Services (QCMS) in writing.  I understand that QCMS through web5star.net will send an invoice to me via email seven days before any charge is made to my card, so that I have the opportunity to check/dispute the charges before they are actually incurred.

Please fax this form to us on +61 7 3410 7880  or  mail it to:
Five Star Web Hosting Services  -  Accounts Administration  -  P.O. Box 948, Bribie Island QLD 4507 AUSTRALIA

Thank you for your payment!