CREDIT PURCHASE AUTHORIZATION / MONIES ISSUANCE FORM
Please Complete and Fax to: 416-644-0139
Important: You must include a photocopy of your credit card(s) and Valid Drivers License or Passport. Make sure your photocopy is readable. We recommend enlarging to 120%.
TELEPHONE DEPOSITS
I, do hereby certify and attest that I am the authorized cardholder for the below listed credit card(s) and agree to pay for the E-Cash purchased under the captioned Electronic Financial Services (EFS) account using the credit card(s) indicated below. I confirm that I have used the services of EFS (Credit Card Processor and Gateway Financial Services Ltd (Merchant Account), and agree to pay the below listed amount.

Please Select (check one or both):
 I do hereby authorize Gateway Financial Services Ltd to charge my credit card and deposit funds into my EFS account for the amount listed below.
 
Credit Card Number Expiration Date Payment

I do hereby authorize Gateway Financial Services Ltd to charge my credit card(s) in each instance that I verbally authorize a deposit to my EFS account over their recorded telephone lines.
 
Credit Card Number(s)* Expiration Date
* Your credit card(s) will be charged per your verbal instructions in the exact order that they are listed.

Authorized Signature ____________________________________  Date________________

INTERNET / ONLINE DEPOSITS
I , acknowledge that he maximum amount of E-CASH that I can purchase for my EFS account is currently US$1,000 per day, and I do herby request and authorize EFS and Gateway Financial Services Ltd to increase my maximum online deposit amount to US$10,000 per month. I will take every precaution necessary to ensure the security of both my USERNAME and PASSWORD and will take full responsibility for all charges posted to my EFS account in the event of fraud.
Credit Card Number Expiration Date

Authorized Signature ____________________________________  Date________________