AUTOMATIC CREDIT CARD BILLING AUTHORIZATION FORM

 I authorize LenAir to deduct from my credit card my monthly internet access fee.  I understand
that my authorization will remain in effect until I have notified LenAir  in writing  prior to my current
subscription expiration. Internet access is a prepaid service which cannot be refunded once the
subscription period has begun.

I acknowledge that LenAir will attempt to run my payment for the next month of service prior to
my current subscription expiration.  If payment is declined, LenAir billing will attempt to contact me
for another method of payment.  If payment is not captured by the first of the service month, the
account will be shut off.  Data is automatically deleted from the servers after 7 days.


NAME:_________________________________________________ (as it appears on card)

ADDRESS:_____________________________________________________________________

______________________________________________________ (billing address of card)

PHONE:________________________________________________________________________

EMAIL ADDRESS:________________________________________________________________

(please choose one)    [  ] Visa     [  ] MasterCard      [  ] Discover          
         

Card Number: ****-****-**______-__________ Fill in last 6 digits (call with full number)

Expires:__________________    CVV#_________ (3 digit verification on back of card)

Account User Name:___________________________

Monthly Dollar Amount Authorized for AutoPay: $______.____

A new form is required if the dollar amount is changed or if you receive a new card.


Signature:___________________________________________ Date:______________________
	
All customers are bound to the Terms & Conditions posted online at
http://www.lenair.net/policies.html

Return this form to us to initiate monthly auto pay.

LenAir                                     
P.O. Box 573                               
Adrian, MI  49221                            

Contact LenAir ... by phone:  1-877-455-0514 ... via email: billing@lenair.net

      is a subsidiary of Lenawee Air Network LLC