Payment Advice Form

Name:

  

Date:

  

Address:

    

   

Invoice number:

  

Domain Names covered by this payment/authority:

    

Payment method:

     Cheque     Money Order     Credit Card

Payment by Cheque or Money Order

I have enclosed a cheque for $___________

Please make Cheque/Money Order payable to QCMS and write your domain name or invoice number on the back of your cheque.  Please do not staple cheques.   Please post your payment, together with this form to:

Five Star Web Hosting Services   PO Box 165, Wynnum   QLD  4178  AUSTRALIA

Payment by Credit Card

Type of card:     VISA     MasterCard
Name on card:  
Card number:  
Three-digit CVV code* (compulsory):  
Expiry date:  
Cardholder signature:  

* Your three-digit CVN code should be printed on the back of your card directly following your card number.

Please tick one box:

Make a one-off charge to the credit card I have indicated above for the following amount:  $___________
Each quarter, charge my quarterly web hosting fees to the credit card I have indicated above until I cancel my web hosting account, which I may do at any time by notifying Qld. Computer Management Services (QCMS) in writing.  I understand that QCMS through web5star.net will send an invoice to me via email seven days before any charge is made to my card, so that I have the opportunity to check/dispute the charges before they are actually incurred.
Each year, charge my annual web hosting fees to the credit card I have indicated above until I cancel my web hosting account, which I may do at any time by notifying Qld. Computer Management Services (QCMS) in writing.  I understand that QCMS through web5star.net will send an invoice to me via email seven days before any charge is made to my card, so that I have the opportunity to check/dispute the charges before they are actually incurred.

Please fax this form to us on +61 7 3393 3562 or  post it to:   Five Star Web Hosting Services PO Box 165, Wynnum   QLD  4178  AU

Thank you for your payment!