It is necessary for you to complete each field (from your computer) and print out this entire document. Please sign it, and mail or fax the entire document back to us with the rest of your application for reseller status.

Credit Card Information:

Write Brothers is now accepting MasterCard, Visa, and Discover credit card payments on orders. If you choose to take advantage of this offer please fill out the information below and mail this documentation to my attention.

This document must be on file to make credit card purchases. A separate completed document is necessary for each card you may wish to use. If you need to return any products, you must follow our regular RMA procedure. Returns and charge backs on credit card purchases may cause your reseller status to be revoked permanently.

Card Holder Name:

Company Name:

Billing Address:


Billing City:

Billing Postal Code:

Billing Country: