beeoptions Credit Card Authorisation Form

Please e-mail a scanned copy to Compliance@beeoptions.com

By submitting this signed and dated form, along with the additional information required as listed
below, I am authorising and fully acknowledging the following:

A. I am the authorised cardholder and will honour all purchases initiated by me to my

account with the below credit/debit Card, whether completed by telephone or otherwise.
B. I am of age (at least 18 years or older depending on your jurisdiction).
C. I have read and accepted the Terms of Use as listed on the beeoptions site:
beeoptions.com/termsofuse

CUSTOMER ACCOUNT ID: _

FULL NAME PRINTED: _

PHONE NUMBER: ( ) - _

CARD TYPE:
Visa
Master Card
American Express

CREDIT CARD NUMBER: (first 4) -xxxx-xxxx- (last 4)

CARD EXPIRATION DATE: / (mm/yy)

ADDITIONAL REQUIREMENTS ENCLOSED:

1. Colour copy of government issued photo ID (both sides).

2. Colour copy of the applicable credit card used to deposit (both sides). You must cover the
middle eight digits and security code while leaving the first and last four digits visible.
3. Proof of address dated from within the past 3 months (utility or phone bill will suffice).

I hereby authorize the above, as evidenced by my signature below.

_______________ ___________________________
Date Customer Signature

For support, contact us on LivePerson (beeoptions.com), email (support@beeoptions.com) or telephone:

United Kingdom: (+44) 203.695.0389 | Toll Free: 888.228.5923 | Brazil: (+55) 614.042.1077
Russia: (+7) 499.403.3613 | South Africa: (+27) 10.500.8619 | Australia: (+61) 38.820.5901