I agree that the above details are true and correct.
For credit card payment, I understand that my credit card will be debited for all set-up charges and monthly in advance for the access fee.
Once connected, I agree to abide by the terms and conditions found at PCM- agreement or available on hardcopy upon request.
This form must be signed if submitting by hardcopy. The signatory must be at least 18 years of age.