Customer Payment Form

Company Code: *

(e.g. s1234)

Which length of services would you like to choose?

Payment Option:

3 months services (US$15 X 3 = US$45)

6 months services (US$15 X 6 X 90% = US$ 81)

9 months services (US$15 X 9 X 80% = US$108)

12 months services(US$15 X 12 X 70% = US$126)