2. You represent and warrant that the Photo ID you attached to this application accurately depicts you and is true and accurate, you further represent and warrant that you are not a minor and that the following information provided by you in this section is true and accurate and you agree to immediately update us in writing with revised true and accurate information as such information changes:
Under penalty of perjury, I, , hereby attest, affirm, confirm and swear that I am the actual authorized user of the
User ID: (Password: )
Furthermore, I swear that I am the actual authorized user of the debit/credit-card number used to establish and process charges for this User ID. This
Debit/Credit-Card number: Expires:
The billing address to which your credit-card statements are mailed is as follows:
Street:
Apt:
City: State:
Zip: Country:
Mother's Maiden Name:
Date of Birth: / /
Daytime Phone number:
Evening Phone number:
Primary email address:
Alternate email address:
3. By signing this Agreement, you acknowledge that you are a "V.I.P." user who may incur charges exceeding $300.00 per day, and that you are fully liable and responsible for all such charges. Moreover, you understand that purchases are subject to a "NO REFUNDS" policy to the fullest extent permitted under the applicable law and that your use of the Streamray services manifests your agreement to the Terms of Service posted at the time you log in as well as the provisions found in this Addendum Agreement and that Streamray may terminate or modify the terms of this VIP Addendum Agreement at any time consistent with the manner Streamray may terminate or modify the TOS in effect at the time and nothing in this Addendum Agreement or in communications from Streamray personnel or written on the Sites shall be construed to the contrary.
Signature: ______________________________________________________________________________
Name (print): ____________________________________________________________________________ Date:________________
DIRECTIONS FOR FAX SUBMISSION: Print out this form, complete it, sign it, and fax it and a copy of a photo ID such as a drivers license or passport and a copy (front and back) of your credit card you intend to use, to +1 (408) 744-9372. (If you are not in the U.S., the number is +1 +1 (408) 744-9372 or toll-free domestic at (866) 942-2084). A Streamray, Inc. customer service representative will promptly perform the necessary indications on your account profile and notify you via email of same. Shortly following receipt of your fax, we will email the primary email address you provided above with confirmation of receipt. If you do not receive a confirming email within a few hours after transmitting it, please re-fax the form.
DIRECTIONS FOR EMAIL SUBMISSION: Print out this form, complete it, sign it and scan it and a copy of a photo ID such as a drivers license or passport and a copy (front and back) of your credit card you intend to use. Attach the scanned images file to an email to: vip@streamray.com. A Streamray, Inc. customer service representative will promptly perform the necessary indications on your account profile and notify you via email of same. Shortly following receipt of your email, we will email the primary email address you provided above with confirmation of receipt. If you do not receive a confirming email within a few hours after transmitting it, please re-submit the email.
DIRECTIONS FOR MAIL SUBMISSION: Print out this form, complete it, sign it along with a copy of a photo ID such as a drivers license or passport and a copy (front and back) of your credit card you intend to use, and mail it , along with a photocopy of positive identification to: Streamray Inc., . However, we will not be able to activate your VIP account until we receive your mail.
NOTE: YOU MUST ATTACH A PHOTOCOPY OR SCAN OF POSITIVE IDENTIFICATION (Photo Identification), Credit Card and this Form.