PAC Authorization Form


One Time Credit Card Payment Authorization Form

Sign and complete this form to authorize Sky Wireless Communications Inc to make a once time debit to your credit card listed below. By signing the form you give us permission to debit your account for the amount indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.


First Name	*
Last Name	*
Business Name
Street #	*
Street Name	*
Suite / Apt #
City / Town	*
Province	*
Postal Code	*
Business Phone	*
Email address for confirmation	*

Credit Information



Credit Card Type	*
Credit Card Number	*
Credit Card Expiry Month	*
Credit Card Expiry Year	*
Digit Security Codes	*
Charge Amount	*
SKY WIRELESS SALES REP	*