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Name*

First Name

Last Name

Email*

Input your email if you wish to receive a summary of your purchase.

Discount Code (Like Us on Facebook and Save $10 (enter code 10) )

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What would you like to pay for?*

Deposit KS Care ($299/year) KS Care 24/7 ($599/year) KS Care 24/7 VIP ($1199/year) Balance of Invoice

Proposal # or Invoice #

Amount*

(Amount on contract)

Amount to be Charged via ACH (Preferred Customer Discount Applied) $

(Amount after e-check discount)

Amount to be Charged via ACH (Facebook Like Discount Applied) $

Amount to be Charged to Credit Card (Invoice/Deposit Amount Under $5000) $

(3% surcharge for Credit Card charges over $5000)

Amount to be Charged to Credit Card (Invoice/Deposit Amount Over $5000) $

(3% surcharge for Credit Card charges over $5000)

Amount to be Charged to Credit Card >$5k (Facebook Like Discount Applied) $

(3% surcharge for Credit Card charges over $5000)

Amount to be Charged to Credit Card $

(3% surcharge for Credit Card charges over $5000)

E-Check / ACH Payment Option

E-Check ACH (preferred payment option)

Credit Card Payment Option

Credit Card (Invoices/Deposits > $5000 will incur a 3% convenience fee)

Credit Card Payment Details

Card number

Expiration date

CVC

Billing Address

ZIP Code

Credit Card Authorization

I authorize KS Audio Video to charge the card listed above

*All monthly services are charged quarterly or annually. The initial payment will include a prorated amount for the current quarter or year. Subsequent years the annual tune up will be charged the first week of January. All services are non-refundable and all sales are final. For a complete list of terms and conditions please visit www.ksaudiovideo.com/terms. By signing below, I hereby confirm and acknowledge that I agree to the terms and conditions on the KS Audio Video website.

Signature

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E-Check / ACH Payment Details

Bank Routing Number*

First set of numbers at bottom, 9 digits

Bank Account Number*

Account Type*

ACH Authorization*

I authorize KS Audio Video to draft the account listed above

*All services are non-refundable and all sales are final. For a complete list of terms and conditions please visit www.ksaudiovideo.com/terms. By signing below, I hereby confirm and acknowledge that I agree to the terms and conditions on the KS Audio Video website.

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