| Personal Information | |
| User name: | ______________________________________________ |
| First name: | ______________________________________________ |
| Last Name: | ______________________________________________ |
| Address: | ______________________________________________ |
| Address: | ______________________________________________ |
| Telephone: | ______________________________________________ |
| E-mail: | ______________________________________________ |
| Credit Card(s) Details | |
| Card #1 | |
| Cardholder Name: | ______________________________________________ |
| Card Type | ______________________________________________ |
| Card Number | ______________________________________________ |
| Card #2 | |
| Cardholder Name: | ______________________________________________ |
| Card Type | ______________________________________________ |
| Card Number | ______________________________________________ |
| Card #3 | |
| Cardholder Name: | ______________________________________________ |
| Card Type | ______________________________________________ |
| Card Number | ______________________________________________ |
| Card #4 | |
| Cardholder Name: | ______________________________________________ |
| Card Type | ______________________________________________ |
| Card Number | ______________________________________________ |
| Card #5 | |
| Cardholder Name: | ______________________________________________ |
| Card Type | ______________________________________________ |
| Card Number | ______________________________________________ |
| I,_________________________, hereby certify that I am the cardholder for the above credit card(s) and agree to pay for the E-cash purchased under the captioned EFS account using the credit card(s) indicated above. | |
| I hereby acknowledge that the maximum amount of E-cash I can purchase for the above EFS account is US $ 2,000 per month, and I authorize EFS to increase my maximum monthly amount to $ 5000. I will take full responsibility for eventual fraud against my EFS account, and will take every precaution necessary to ensure that my user name and password are safe and secure. | |
| Signature: Date:____________________
|
|
| Electronic Financial Services Caribbean Inc.(EFS), a
company incorporated in the country of Antigua, is a wholly owned subsidiary of Starnet
Communications International Inc. Starnet is a fully reporting, US public company listed
on the National Association of Securities Dealers' Over-the-Counter Bulletin Board market
under the trading symbol "SNMM" EFS Caribbean Inc. acts as the on-line financial transaction processor for Internet services offered by Starnet, its subsidiaries and licensees. By utilizing Starnet's proprietary STAR-MX encryption and processing technologies, EFS Caribbean guarantees complete security and confidentiality of all your on-line credit card charges; the STAR-MX system was the first of its kind to be certified by a Canadian chartered bank (Bank of Montreal) for Internet monetary exchange. Let us take this opportunity to thank you for your patronage. If you have any inquiries regarding your EFS account, please do not hesitate to contact us at EFS: Phone: 1-888-685-7619 Fax: 604-608-6041 email: [email protected]" |
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