Psyberware offers the option to have your monthly balance paid automatically via credit card at the beginning of each month. This service is provided at no additional fee as a convenience to our customers.

If you would like to pay your monthly bill with your credit card, please print out the form below, fill in the blanks and sign it. All requested information must be completed. If you are using a parent's credit card, he/she must complete and sign the portion below.

Please mail the completed form to:

Psyberware
533 G St Ste 1B
Lincoln, CA 95648

This form can also be faxed to (916) 645-4597.

I authorize Psyberware to bill all charges for my account to 
my credit card as designated below, until such time as I 
notify Psyberware in writing of termination of this 
authorization. If my credit card is lost, stolen, terminated 
or expires, for any reason, I will promptly notify Psyberware 
and my credit card provider.


___ Visa      ___ Mastercard      ___ American Expresss


____________________________________________________________
Credit Card#                           Expiration Date


____________________________________________________________
Name as spelled on card


____________________________________________________________
Signature                                          Date


____________________________________________________________
Psyberware Account User ID