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Credit Card Billing Information  

Account Number or Username:
If Unknown, leave Blank
        
First Name:   
Last Name:   
Address 1:   
Address 2:  Prov/State:  
City:  P.Code/Zip:  
Country: 
E-mail Address:  
 
Credit Card Information
 
Card Number: 
Card Type:     Exp. Date:  /  
Card Validation Code:  ( a 3 or 4 digit, non-embossed, printed on the front or the back of the Card) 
Issuing Bank: 
(Visa and MasterCard)
Charge Amount:
 
Please note: All personal and credit information submitted must be valid. For security purposes, any information submitted will be subject to verification. Any accounts with incorrect or invalid information will be disabled at our discretion.    

 

Terms and Conditions  
Bonanza Enterprises does not warrant that the service or product is completely error free or will operate without loss or interruption. The undersigned hereby agrees to be responsible for payment of all applicable charges on the undersigned's detail report incurred as a result of the use of the undersigned's account, including but not limited to the use or misuse by an unauthorized third party, or any error, accidental use or loss. In no event will Bonanza Enterprises be liable for any indirect, special, incidental or consequential losses or damages arising in any manner from the use of its services or products. Bonanza Enterprises will not offer any refunds or reimbursements for the purchase price, except where through its own fault.
 
Sign below to confirm that you have read, understand and agree to the contents of the above paragraph. Your Electronic signature is assumed by your submission of this form.

__________________________________________________
Signature Date  

Email completed form to bonanza@comettele.com. Submit here

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