Econdataweb - Fax Form


	FAX
					To: Econ Dataweb

					Fax number: (+34) 952667206

					Date:

- Fax Payment Form

Dear Econ Dataweb,
Please charge my credit card (as detailed below) for the Econ dataweb service and amount outlined as follows:

Service type:

Note:

Service:

You need to fill in the amounts form our list of prices for the service you are selection, if these are not filled in we cannot process the form.

Sub total:

VAT:

Payment total:

Client Details

Company:

First name

Surname:

Address:

Number:

Street:

Town:

Postcode:

County:

Country:

E-mail:

I ..................................... authorise Econ dataweb to charge my credit card the amounts outlined on this form. I also agree that the minimum term of service is for a 12 month period if not cancelled within 30 days of the date of this document.

Comments:

Type any comments here but remember this is being faxed so whatever text you can't see will not be shown on the fax.

Credit Card Payment Details

Name on card:

Card type:

Visa - Master card - 4B - Am Ex'

Signature

Card number:

(No spaces nor dashes)

Last 3 digits on back of card

x...................................

Expires:

- / -

You can fill this form in on your computer then print it out, or print it out first then fill it in.
Use the browser print button to print this page, then send it to the following number, if you are faxing from outside Spain: (This fax is sent to Malaga in Spain, dial your international access code, normally 00) then, 34 952 667206
If you are faxing from within Spain you only need dial: 952 667206