*First/Last Name:   /  

*Email:

*Contact Phone #:

*Address

*City    State: AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPAPRRISCSDTNTXUTVAVTWAWIWVWY    Zip:

I hereby authorize Hosted Concepts LLC (dba CustomerVault) to charge my credit card for my monthly service fees. I agree that this is a periodic charge that will be made monthly, and that to terminate the recurring billing process I must cancel my account.

I understand that all account cancellations should be emailed to questions@customervault.com. I will not dispute the recurring billing with my credit card issuer as long as the amount in question was for service rendered prior to my cancelling my account.