ONLINE PURCHASE TRANSACTION AGREEMENT FORM
Verification and Authorization of Online Transaction
Fax Number: 1866 369 0548 or e-mail: ccprocessing@prismcasino.com

Account Name: __________________________

User ID: ______________________


This is to acknowledge and authorized the charges made into my credit card(s) (as shown below). I do acknowledge that the transactions made were credited to my online account with PC Entertainment Inc.

I acknowledge this purchase(s) and agree that all sales are final. I acknowledge that I have read the entire agreement and understand that I will be held fully responsible for its terms and charges as defined within the terms of agreement.

CREDIT CARD ACCOUNT INFORMATION

Card Name (as shown on credit card) ______________________

Credit Card Number(s) and Exp date:

_____________________________ Exp date_________

_____________________________ Exp date_________

_____________________________ Exp date_________


I hereby declared that I am the legitimate owner of the above-mentioned credit card. Note: Please send copy of the credit card

FOR any FURTHER PURCHASES using ANY OF these credit cards: (please choose one)

____As the credit card holder, I also authorize PC Entertainment Inc. to charge my credit card for future purchases verbally or electronically approved by me.

Authorization valid until _____/_____

Signature/Initials: ______________

____ I will send this form again and they can ask again for any other purchases.


Signature: _____________________________ Date: ______________

If there are changes in your Account Information, Please fill up the following:

Change of Address: ______________________________________________________________

______________________________________________________________________________

Change of telephone number or additional phone number:
______________________________________________________________________________

Change of email address: _________________________________________________________