Payment Method:
Paypal
Telegraphic Transfer
Charge The Amount Of (Amount In Words): ______________________________________________________
Card #____ - ____ - ____ - ____
Expires ____ / ____
Bank Name _______________________________________
Name of card holder: ________________________________________
I hereby authorized the above amount in ____________ to be charged to my card credit.
_________________________________ Cardholder Signature
Date: ____________________
Cardholder's billing address and zip __________________________________________
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