Please fill this form on-line, print it, sign it and fax it to 604-608-9403
.
Credit Card Payment For MLS Listing Services (VISA or Mastercard only)
Owner's name
First name ........ Last name
Property address
City
I authorize Olympia-Pacicific Interactive Realty to debit my credit card the amount of: (please check one)
$729.75 ($695.00 listing fee plus $34.75 GST @5%) or
$
Credit Card to be used (please check one)
Card number (please enter 4 numbers per box)
Expiry Date (please enter 2 numbers per box)
month year
Name shown on card
Today's date:
Date Month Year
Signature of cardholder
__________________________________________