Additional Chekel Request Fax

Please print this page and fill in the appropriate information

If you want to apply for permission to purchase additional chekels the following information must be faxed or mailed to Brian Pollock, Office Manager, ICC:

Credit Card information: Name as it appears on the card, card number and expiration date. Name:_______________________
Credit card number:_______________________ Expiration date:____________
Enclose a copy of the front and back of your credit card.
On the enclosed copy include the handle name and signature of the credit card holder.
Enclose copy of photo identification of the credit card holder.
State clearly the amount of extra chekels you want to purchase. Amount:______________

The above information can be faxed directly to the ICC office: (412) 521-5575. Or mailed to the ICC office:

Internet Chess Club
ATTN: Brian Pollock
5820 Forbes Avenue
Suite 1
Pittsburgh, PA 15217
USA