APPENDIX G
ITNET REGISTRATION FORMS
®
ITNET DEBIT ACCOUNT FORM
You MUST have this form on file at Incredible Technologies, Inc.
or your games will not be activated for online play.
After processing of the ITNet® forms, a personalized Operator Identification Card will be mailed to you.
The Operator Identification Card allows you to immediately register your games on-site.
Billing Information for Automatic Debit Payments
Authorization Agreement for Pre-authorized Payments For participation in ITNet®
I (we) authorize Incredible Technologies, Inc., hereafter called COMPANY, to initiate debit entries to my (our) bank account indicated below. I (we) authorize the
financial institution named below, hereafter called INSTITUTION, to credit the amount of such entries to my (our) account to correct any errors, and the Institution
to deposit any such corrections to my (our) account. I have attached an unsigned and voided check for the account I wish to be debited from time to time and in
varying amounts.
Please Print Clearly and Legibly to Insure Accuracy.
Checking Account
Savings Account
Company
Name
Address
Bank
Account
Number
City,
State,
Zip
Bank
Routing
Number
(VERY IMPORTANT)
Company
Contact
Bank
Name
( )
( )
( )
Phone Number
Fax Number
Bank Phone Number
To assist in verifying data, please attach an unsigned voided blank check from your account.
The authority is to remain in full force and effect until I (we) revoke the agreement in writing as hereafter provided. Any revocation is effective only after
COMPANY has received written notice from me (us) to terminate this agreement in such time and manner to afford a reasonable opportunity to act upon the
notice. I (we) have the right to stop payment of a debit entry by notification to the Institution in such time and manner to afford a reasonable opportunity to act prior
to charging the account. A copy of this authorization will be provided at your request.
Email Addresses
Incredible Technologies® can alert you to a variety of information through email.
Please fill in the name and email address of the parties responsible for the following areas:
Main
Main
Contact
Name
Main
Contact
Address
Billing
Billing
Contact
Name
Billing
Contact
Address
Technical
Technical
Contact
Name
Technical
Contact
Address
Promotions
Promotions
Contact
Name
Promotions Contact Email Address
Authorized
Signature
Date
Signature MUST accompany this form.
Fill out this form completely and mail or fax to:
Incredible Technologies, Inc.
3333 N. Kennicott Ave. Arlington Heights, IL 60004
(847) 870-7027 Phone (847) 454-9156 ITNet Registration Fax
Allow up to 10 Business Days for Processing.
Silver Strike Bowler’s Club™
Version 01/09
Page 81
© Copyright 2006-2009 Incredible Technologies, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable law.
All other marks are the properties of their respective owners. All rights reserved.
