CVV2 or CID (3 or 4 digit security code): __________________________________________
IMPORTANT: THE SECURITY CODE IS A REQUIREMENT. WE MUST HAVE THIS CODE IN ORDER TO PROCESS YOUR ORDER. VISA/MC/DISCOVER:Visa, MC and Discover all use 3 digit codes located on the back of the card, following the credit card number. AMERICAN EXPRESS:American Express uses a 4 digit code located on the front of the card, separate from the credit card number.
ORDER AMOUNT: (5 choices - circle your choice) $19.99 $34.99 $47.99 $59.99 $72.50
TOTAL AMOUNT: (order amount) $_______________________________________
I hereby certify that I am the authorizing card holder of this account.
I understand that I will be billed for the total amount calculated above.
I understand that the
name appearing on my credit card billing statement will be either
"Austin Research Institute via InternetSecure" or "PAYPAL AUSTINRESEA".