VULTR.

com Credit Card Authorization Form

Vultr.com Account: 7plus2017@gmail.com
14 Cliffwood Ave Suite 300 NGUYEN QUANG BINH
Matawan, NJ 07747 Thn 10 x hi xun
Phone: 973-849-0529 | Fax: 732-566-1268 H NI VN

Please attach the following information to your open support ticket for verification using the customer portal at
https://my.vultr.com/support/

1. A copy of your government issued photo ID - driver's license, passport, etc. (Please use a camera phone or digital camera to
take a photograph)
2. A partial image of the card used to fund the account to ensure the provided identity matches the name printed on the card. For
your protection, please cover all but the last 4 digits of the card. (Please use a camera phone or digital camera to take a
photograph)
3. This completed form.

I authorize vultr.com to bill my credit card account for subscriptions and bandwidth overage incurred under my account
7plus2017@gmail.com.

Account Information:
NGUYEN QUANG BINH
Thn 10 x hi xun
H NI , VN

Credit Card Type (circle one): Amex Discover Visa Mastercard

Credit Card: 4221 0930 0090 0878

Last 4 Digits 0878 Exp. Date (mm/yy) 10/21

Owner of Account: NGUYEN QUANG BINH

First Name BINH Family Names(s) NGUYEN QUANG

Address: DOI 10a HAI XUAN

Street Hi Xun City MONG CAI

State/Province QUANG NINH Zip/Postal Code 260000 Country/Region VIET NAM

Phone: +84988943682 Fax: E-mail: binhtiente@gmail.com

Signature of Cardholder: Bnh Date: March 2, 2017