ARINC-Cybertime:: E-Payments

The fields marked with a * are required and your card cannot be processed without them.

BILLING INFORMATION

First Name:	*
Last Name:	*
Address:	*
City:	*
State:	*
Zip:	*
Phone:

TYPE OF PAYMENT *

Wireless Broadband Services

1 Month Wireless Broadband $49.95
1 Month Wireless Broadband $79.95

Normal Services:

1 Month Personal Dial-up @ $19.95 per month
3 Month Personal Dial-up $56.85 @ $18.95 per month

Discounted Services:

(NOTE: If you are not already subscribed for these services, we will not accept your payment.)

1 Month Senior Dial-up @ $16.95 per month
3 Month Senior Dial-up $47.85 @ $15.95 per month

For a special amount or other service, you may use the space below to let us know how much you would like us to charge.

Other Amount:		$

CARD INFORMATION

Enter the name shown on your credit card:
*
Credit Card Type:		*
Credit Card Number:		*
Expiration Month/Year:		/ *
CVV/CVC/CID Number:		*


QUESTIONS AND COMMENTS



By submitting this form, you authorize ARINC-Cybertime Network Services to charge your credit card or debit your checking account for the amount indicated above.

(Your initials in this box below constitutes your electronic signature)
Initials: *