Extended Credit Agreement

I, _______________________________________________ (full name), hereby confirm and swear that I am the actual authorized user of the following ScreenName(s) that I use in the Live Webcams section of Wasteland, operated by CC Network, Inc.:

  1. ScreenName: ________________________________________________

  2. ScreenName: ________________________________________________

  3. ScreenName: ________________________________________________

I also hereby confirm and swear that I am the actual authorized user of the following credit card(s):
  1. Credit card number: ______________________________  Expires: _____________

    Name on credit card: ____________________________

  2. Credit card number: ______________________________  Expires: _____________

    Name on credit card: _____________________________

  3. Credit card number: ______________________________  Expires: _____________

    Name on credit card: _____________________________

The address where my credit card(s) statements are mailed to is:
Street: _____________________________________________________________

City/State/Zip (Post Code)/Country: ________________________________________

___________________________________________________________________

If the above address is a P.O. Box or is not your permanent residence, then please write your permanent address here:
Street: _____________________________________________________________

City/State/Zip (Post Code)/Country: ________________________________________

___________________________________________________________________
PAYMENT LIABILITY: By signing this agreement, I confirm that I am an active user of the site and may make frequent use of the 'premium' services which attract a charge, for which I will be fully liable and responsible. I also confirm that I shall regularly view my session details as displayed in 'Viewer Services' and if I disagree with any charges to inform CC Network, Inc. before contacting my credit card company. This commitment shall continue until I cancel my account by notifying CC Network, Inc. using the form on the Contact Us page. I also confirm that I understand that CC Network, Inc. operates a no refunds policy, but may, at its discretion, credit me with free time in the event that I experience technical difficulties which I genuinely tried to overcome, or am purposely deceived by one of the Chathosts.

CONFIRMATION OF MY IDENTITY

My date of birth is: ___________________________________________________________

My phone number is: _________________________________________________________

My email address is: _________________________________________________________


Signature:______________________________________________

Name (print): ___________________________________________

After you have printed the form, please click here to return to the instructions page.