TEAM EFFORT INTERNATIONAL

Credit Card Authorization

Thank you for purchasing the MyVideoTalk Total Solutions Package. In order to complete your purchase
additional credit card verification information is required.

To complete the activation process please complete this form, photocopy front and back of credit card (with
signature on card) and a photocopy of your Government ID (with photo and signature). If you're purchasing
more than one account, you will need to send in a separate form for each purchase.

Representative Information (Please Print Legibly)

First Name: Last Name:

City: State / Country: Rep Account ID (Required) :

Home / Work : Mobile : Email (Required):

**CreditCard Holder Information below is required**

Card Type: MC VISA AMEX DISC

Name On Card: ____________________________________ Credit Card#: _______________________________

Exp. Date: ______________ / ______________ Billing Phone Number : _________________________________

Billing Address: _______________________________________________________________________________

City: _____________________________ State / Country: ____________________ Zip Code: ____________

I _____________________________ certify that the payment and all information in this form is valid.
(Card Holder Name)

I have also read and understood the Company's:

1. Terms & Conditions

2. The company's Refund / Cancellation Policy

I hereby authorize Team Effort International to charge my credit card for my purchase of the
MyVideoTalk Total Solution Package.

CardHolder Signature: _______________________________________________ Date: __________________

Please Fax all documents to USA Corporate Offices +1 – 925 – 891 – 3502

Or Scan and email to support@myvideotalk.com