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Pay by credit card: Print the credit card form below. Fill out completely. Fax, mail or scan/email NCR. (fax to: 775-324-1399, mail to: 955 S. Virginia Street, Reno, NV 89502, email to: info@des-ncr.com) Call NCR Toll Free (866) 910-2089 DES-NCR Credit Card Authorization Type of Credit Card:
Credit Card Number:
Expiration Date (MM/YY): V-Code (3 Digit Security Code):
/ Billing Information of Credit Card: Cardholder Name: Name of Authorized User: Billing Address: Billing City, State, Zip: Contact Telephone Number: ( ) I hereby warrant that I am the person authorized to use the above referenced credit card. I agree to pay for goods and/or services with this credit card authorization and I fully understand that there will be no refunds for any reason once this authorization has been submitted to Downtown Executive Suites, Nevada Corporate Residency or Western Energy, Ltd. I authorize Downtown Executive Suites, Nevada Corporate Residency or Western Energy, Ltd. to charge the above referenced credit card an amount not to exceed: $
Print Name of Authorized Card User Signature of Authorized Card User Date Signed Reference Name of Account for which payment is being made
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Call NCR Toll Free (866) 910-2089 Send mail to
info@des-ncr.com with
questions or comments about this web site.
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