LifeTimeBackup.com

Service

Agreement

User Details

 

Name:   _______________________________________________________________________________

 

Current Mailing Address: ________________________________________________________________

 

City / Town: _________________________________  State / Prov: _____  Zip Code: _______________

 

Telephone Number: ____________________________________________________________________

 

Email Address:  ________________________________________________________________________

Details of Data Provided:

 

Number of CD’s in this Package:  _________           

 

Brief Description of Data:

 

 

 

 

 

 

Please Note:  You Data is Stored “As-Is” - Description is to Aid in Verifying Your Data for Retrieval

 

 

Payment Details:

 

For Pre-Paid Orders, Please List Voucher Number or Attach Voucher

 

Visa / Mastercard Number:      ___________________________________________________________

 

Expiry Date:     _________________________________       CVV2:    ____________________________

 

Name on Card: ______________________________________________________________________

 

Amount to Charge:  Number of CD’s ___________  X Cost per CD $_________ = $_______________

 

Terms & Conditions

Full Terms and Conditions are listed on reverse.  Your signature indicates you have read and agree to these terms and conditions.  At all times, warranty for this service is limited to the amount paid.  If you have questions, call toll-free 877-734-6044.  Furthermore, cardholder agrees to charge to credit card.

 

 

Signature of User: _________________________________________         Date: ____________________