BoiseWiFi-Logos-07-2017

 

2811 S Pond St, Boise ID 83705 / 208-571-4741 office / 208-344-4644 fax / 208-473-1662 support / BoiseWiFi.net /  admin@boisewifi.net

 

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Recurring Payment Authorization Form

Scheduled monthly payments will be automatically charged to the credit / debit card below.

 

Here’s How Recurring Payments Work:

You authorize regularly scheduled charges to the credit / debit card form below.  You will be charged the amount indicated below each billing period. 

 

 

Please complete the information below:   

(PLEASE NOTE: This is not an online form. Simply fill it out, print the page, scan and email or fax it to us.)

 

I authorize BoiseWiFi / Ryals Communication to charge my credit/debit                           

     (full name as it appears on the card)

card indicated below for $ on the  of each month as payment for Internet Service.  

                                            ($$ amount)             (1st or 15th)                                                   
{C}

Billing Address   Phone#

City, State, Zip Email    

                     Credit / Debit Card Info

 

Cardholder Name
Card Number
Exp. Date (mm/yy)
CCV (code#)
 

 

SIGNATURE:   DATE

 

I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify BoiseWiFi in writing by email of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. Email us at admin@boisewifi.net