Credit Card Authorization Form

ICONZ-WEBVISIONS PTE LTD /
ICONZ-Webvisions Sdn Bhd
(A Subsidiary of ICONZ-Webvisions)

ATTN: SALES DEPARTMENT

75 Science Park Drive,
#02-06/07, CIntech II,
Singapore Science Park 1
Singapore 118255


FROM: __________________________________

CASE NUMBER: ___________________________(if any)

DOMAIN NAME / ACCOUNT DETAILS: ___________________________

AUTHORIZATION TO CHARGE CREDIT CARD
                            

    COMPANY NAME:

   EMAIL ADDRESS:

    NAME ON CARD:

    TYPE OF CARD: (Visa / Master) *

   CREDIT CARD #:

 EXPIRATION DATE:

 BILLING ADDRESS
  OF CREDIT CARD:

     ACCOUNTS OR
    DOMAIN NAMES
         PAYABLE:

I authorize ICONZ-WEBVISIONS / ICONZ-Webvisions Sdn Bhd
(a subsisidary of ICONZ-Webvisions) to debit
my credit card as a (monthly / quarterly /
semi-annual / yearly)* (recurring / one-time)*
charge for their services rendered at agreed
published prices.

Should I dispute a charge through my credit
provider this will constitute a breach of
contract. It will also result in immediate
deactivation of all services rendered
by Webvisions or any of its subsidiaries.

* delete where applicable

I have included a photocopy of the credit card both front
and back and have signed the photocopy.

Card Holder
Signature: ______________________________________

Date: ________________





INSTRUCTIONS

Please print, sign, date, and fax to ICONZ-WEBVISIONS /
ICONZ-Webvisions Sdn Bhd
at one of the following offices.

(65)-6773-9389 - Singapore
(61)-2-9281-7642 - Australia
(91)-22-2852-3400 - India
(03)-6205-5253 - Malaysia
(852)-3113-0709 - Hong Kong
(86)-21-63519845 - China
(01)-508-3003065 - USA