Payment Authorization

Cardholder Name & Billing Address:

_______________________________________________

_______________________________________________

_______________________________________________

Phone #: __________________________

E-Mail: ________________________________

Attendee (if not cardholder): ___________________________________

Mailing Address: __________________________________________

_______________________________________________

Phone #: ___________________________

Course#: ___________________________

# of Attendees: __________ x $ _________ Total $ _________

Name(s) of Additional Attendees:

____________________________________________________________

(Circle) AMEX VISA MC

Credit Card #: _________________________ Exp. Date: ___/___

Last three numbers on back of card (VISA/MC): __ __ __ or four numbers (AMEX): __ __ __ __

I, _____________________, authorize Zope Corporation to charge the above credit card for training course attendance. I confirm that the above information is true and accurate.

Signature: ________________________________________ Date: ________________

Mail to:
Zope Corporation
10300 Spotsylvania Ave. Suite 101
Fredericksburg, VA 22408
Or
Fax to: (703) 995-0412

We're betting our company on Python and Zope, that's how good we feel about the technology.
- Ian Prince, Developer, inextenso (Internet and environment system integrators, Switzerland)