Beware Credit Card Form

Hi!.. *smile*.. lets see... if you want to pay by credit card.. then.. simply fill out the form below.

We accept Visa, Mastercard and Discover.. okay?

Thanks!.. *smile*.. love..seph

Enter The Beware handle (account) you are paying for:
If Moving, Enter Your current Handle and chat site:
Enter an Initial Password for this account:
Enter your E-Mail Address:

Your E-Mail is only used if we have trouble setting up the account. It will not be distributed under any circumstances.

Select one of the following:

If paying for a new citizenship..select one of these:
Initial Citizenship plus 4 months ($30.00):
Initial Citizenship plus 6 months ($40.00):
Initial Citizenship plus 1 year ($70.00):

If you are renewing.. select one of these:
Renew for 4 months ($20.00):
Renew for 6 months ($30.00):
Renew for 1 year ($60.00):

If you are moving from one chat site to another.. select this:
Initial Citizenship, Moving Account Only ($10.00):

Name on card:

Birthday (DD/MM/YY):

Address where card is billed:

Line 1:

Line 2:

City:

State/Province:

Zip Code:

Country:

Card Number:

Card Expiration Date:

...........

Name on card:
Birthday (DD/MM/YY):
Address where card is billed:
Line 1:
Line 2:
City:
State/Province:
Zip Code:
Country:
Card Number:
Card Expiration Date:

Thanks for supporting the Beware site!