CREDIT CARD AUTHORIZATION
CREDIT PURCHASE AUTHORIZATION / MONIES ISSUANCE FORM / DEPOSIT LIMIT INCREASE REQUEST
Please Complete and Fax to: 1- 800-201-4919

Important: You must include a photocopy of your credit card(s) and Valid Driver's License or Passport. Make sure your photocopy is readable. We recommend enlarging to 120%.

Please Enter your Customer ID Number below to facilitate processing of your request:

1. TELEPHONE DEPOSITS

I ____________________________________, do hereby certify and attest that I am the authorized cardholder for the below listed credit card(s) and agree to pay for the E-Cash purchased under the captioned Electronic Financial Services (EFS) account using the credit card(s) indicated below. I agree that the maximum amount of E-CASH that I can purchase for my EFS account is currently US$1,000 per day up to a maximum of $6,000 per month over the telephone and a maximum online deposit amount up to US$12,000.00.

(   ) I do hereby authorize EFS, or any other billing agency which EFS uses and notifies me of, to charge my credit card(s) in each instance that I verbally authorize a deposit to my EFS account over their recorded telephone lines.

4. INTERNET / ONLINE DEPOSITS

I ____________________________________, acknowledge that he maximum amount of E-CASH that I can purchase for my EFS account is currently US$1,000 per day up to a maximum of $6,000 per month, and I do herby request and authorize EFS, or any other billing agency which EFS uses and notifies me of, to increase my maximum online deposit amount to US$12,000 per month. (NOTE: Complete above section to exceed your daily online limit of $1000 and monthly online limit of $12000 by depositing with a quick, easy phone call.). I will take every precaution necessary to ensure the security of both my USERNAME and PASSWORD and will take full responsibility for all charges posted to my EFS account in the event of fraud.