_   __     __   ____  _     __
               / | / /__  / /_/ ___/_(_)__ / /__ 
              /  |/ / _ \/ __(_(_  / // _ ` / _ \
             / /|  /  __/ /____) )/ // /_/ /  __/
            /_/ |_/\___/\__/\___/ \_/\____/\___/ CORPORATION
           ------------------------------------------------
          Internet Services Provider   *   www.netside.net


                  CREDIT CARD AUTHORIZATION FORM


Date opened: _____________________  User account: __________________

Cardholder Name
as written on card: ________________________________________________

Company/Organization: ______________________________________________

Billing Address: ___________________________________________________

City: ____________________________  State: _____  Zip: _____________

Phone: ______________________  (day)  ________________________ (eve)

Fax:   ______________________  email: ______________________________

Card Type:  [ ] Amex     [ ] Discover    [ ] Visa     [ ] MasterCard

Card Number: _______________________________________________________

Expiration Date: _________________     Monthly Charge: $ ___________


I hereby authorize NetSide Corporation to bill my credit card for
monthly Internet services in the regular amount indicated above, as
well as any setup fees and optional features, if ordered. The
minimum subscription period for Internet accounts is 1 (one) month.
I agree to pay for monthly charges and all other services I ordered
until I cancel the account.  By signing below, I am entering into a
month-to-month agreement with NetSide Corporation, that will
automatically renew and remain in force until cancelled by either
party upon delivery of a 7-day written notice of cancellation. I
understand that any advance payments for longer periods of service
(i.e., quarterly, semi-annually, or yearly), and setup fees for
accounts, domains, etc. that I may order are non-refundable.


Signature: ______________________________    Date: _________________

Driver license number: ________________________________  State: ____


Please print, complete, sign and return the credit card authorization
form to NetSide Corporation, P.O. Box 403895, Miami Beach, FL 33140,
or fax to 305-531-1975. For service call 305-531-1995. Thank you.