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请帮助我填写一下这个表格,找了几个翻译也弄不明白了,具体是怎么样写呢?
I, _______________________________ hereby authorize PayPal Transaction ID #
_________________________ in the amount of US$ _________.____ which I am
authorized to send from the PayPal account with the registered email address of
____________@_______________ to BurstNET Technologies, Inc.™ (BurstNET®)
accepting payment via PayPal registered email address: billing@burst.net. By
signing this form, I agree with all terms and conditions of the sale/order, as
specified in the BurstNET™ Service Agreement, which I have made over the phone,
by fax, or via the Internet. I also authorize any additional PayPal transactions I
may make in the future to BurstNET™, applied towards recurring monthly service
fees, as well as any additional services or service upgrades, that I request on my
account, and any applicable usage charges.
The registrant information of my PayPal account is:
Account Holder: __________________________ Phone # ___________________
Street Address*:_____________________________________________________
City _____________ State _________ Zip/Postal Code _______ Country _______
* Must be registered shipping address listed on your PayPal account.
I understand that this information will be used for purposes of verification with the
PayPal system to prevent fraudulent usage.
Please note: If your PayPal registered email address changes, or if you wish to
utilize a different PayPal account than listed on this form, you will need to complete
and provide to BurstNET® a new PayPal Authorization Form.
You must attach a legible copy of your Driver’s License (or other valid
photo ID: Passport, Gov’t Identification, etc...) and a legible copy of a
utility bill which was received at your registered PayPal shipping address.
Printed Name: ___________________________________
Signature: ______________________________ Date: _____/_____/_____
Account Identifier : ___________________________________
(ie; Order Tracking # / Invoice # / Account #)
PAYPAL AUTHORIZATION FORM
Please fax back to: 570-343-9533—ATTN: BILLING DEPT
Or
Send via Email w/attachments to auth@burst.net
PLEASE MAKE SURE TO PROVIDE ALL DOCUMENTATION REQUIRED!
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