Credit Card Authorization Form | Miami Beach





*Title (* = required) Mr.Mrs.MissMs.
*First name *Last name
*Company name Job title
*Address Address 2
*City *State
*Country *Zip Code
*Telephone *Email
– Billing address if different from above
Billing address Billing address 2
City of Billing address State of Billing address
Zip Code of Billing address Country of Billing address
* Required fields
Miami Beach Virtual Office Package order/Charge
See package details

Please make a selection.
BASIC
Rate (a month) Setup Fee** Refundable deposit Tax 7% Price USD
$50.00 $50.00 $50.00 $7.00 $157.00
MAILBOX
Rate (a month) Setup Fee** Refundable deposit Tax 7% Price USD
$79.00 $99.00 $79.00 $12.46 $269.46
PLUS
Rate (a month) Setup Fee** Refundable deposit Tax 7% Price USD
$149.00 $99.00 $149.00 $17.36 $414.36
SILVER
Rate (a month) Setup Fee** Refundable deposit Tax 7% Price USD
$199.99 $99.00 $199.98 $20.93 $519.91
SILVER_EXECUTIVE
Rate (a month) Setup Fee** Refundable deposit Tax 7% Price USD
$269.99 $99.00 $269.99 $25.83 $664.81
GOLD
Rate (a month) Setup Fee** Refundable deposit Tax 7% Price USD
$299.00 $99.00 $299.00 $27.86 $724.86
TITANIUM
Rate (a month) Setup Fee** Refundable deposit Tax 7% Price USD
$349.00 $99.00 $349.00 $31.36 $828.36
Extra Services Mail Notification Service ($19.99): YESNO Lobby Sign ($19.99): YESNO
* Anex Office will send an email to the client any time correspondence is received along with sender’s name.
*Start Date MM/DD/YYYY
Contract Length
*Terms and Conditions
I have read and agreed to the Terms and Conditions and by completing this transaction intend this to be an agreement signed by me.

*Initials Signature

Credit Card Details VISA - MASTER CARD
*Name on Card: *Card type:
*Credit Card Number:
*Expiration date: Month *Year:
*Card Verification # / Security Code: Issue Number (optional)