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Mailing address: P.O. Box 130* Casper, WY 82602-0130 |
| Fax number: 307-472-4167 |
I authorize WERCS Communications on or about the 15th of each month to charge my credit card account for Internet access and related service.
| Account Number: | ____________________________________________________________ | ||
| Expiration Date: | ____________________________________________________________ | ||
| Signature: | ____________________________________________________________ | ||
| Print Name: | ____________________________________________________________ | ||