TelAlaska

AUTO PAY TERMS AND CONDITIONS

As an enrollee in this program, I understand that :

1. I will receive a bill monthly, even though I am enrolled in the autopay program. This bill will advise me of the amount to be charged to my credit card between the 15th and 25th of the billing month.

2. If charges to my credit card are declined for any reason, TelAlaska will make an attempt to contact me for an alternate payment arrangement. If I cannot be contacted, or fail to make alternate payment arrangements, my account will be subject to normal credit procedures for non-payment. If charges to this credit card are declined twice within a twelve-month period TelAlaska has the right to terminate this autopay agreement.

3. I am responsible for notifying TelAlaska if I wish to cancel this agreement.

4. If my credit card number changes for any reason, including lost or stolen credit cards, I will notify TelAlaska of the new account information. If I fail to provide this information prior to the 15th of the billing month and TelAlaska is unable to process my payment, I will be responsible for an alternate payment arrangement and any late charges which may result.

5. TelAlaska may cancel or update this agreement, at any time, upon 30 days written notice.

YOUR BILLING NUMBER:_______________________________

YOUR MEMBER NUMBER:_______________________________

New Setup           Change

YOUR NAME: ________________________________________
( Print name exactly as on credit card )

ADDRESS:__________________________________________________________________________
(Billing address of your credit card)

CREDIT CARD TYPE: (please circle only one)   VISA          MASTERCARD

CREDIT CARD NUMBER: _______/________/_______/_______

EXP. DATE: _____/_____

I, the undersigned, authorize TelAlaska, Inc. to charge my TelAlaska billing to the credit card indicated above. I have read and understand the above information and I agree to the above autopay terms and conditions.

Signature: ___________________________________ Date: ______________

Return to:
     TelAlaska, Inc
       PO Box 233609
       Anchorage, AK 99523
       1-800-478-3127