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SUBSCRIBER INFO CHANGE FORM USER GUIDES
INFO REQUEST AND COMMENTS
Pay an Invoice Make a payment on your account by filling in the following information Account information:
(* indicates required information) *Name: Company: *Address: *City: *State: *Zip Code: Invoice number: Due Date: *Voice/Fax number (shown as P O number on invoice) Please include area code: E-mail address (your conformation will be sent here);
Billing Information
*Credit card type: visa Master Card Amex Discover *Credit Card ID # *Card Number: *Expiration date Month: 01 02 03 04 05 06 07 08 09 10 11 12 *Year: 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 *Amount to be charged: Card holder's name and billing address: Same as above: Name: Address: City: State: Zip Code:
Please automatically charge my credit card on renewals:
* Location of Credit Card ID Information:
Email: receivablesmbi@netscape.net
Phone: 212-255-3155 Fax: 212-255-4015 Copyright Message Bureau Inc. 2002 37 Union Sq. West New York, New York 10003 All rights reserved
Fast Connect is a registered trademark of Message Bureau Inc.