Владелец кредитной карточки подтверждает оплату
To credit card payment we need details as follow. Please send it by fax + 371 67222612.
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ASTRA TURE SIA/AvioKase.lv Maza pils 5 Riga, LV 1050, Latvia Date: ………………
CREDIT CARD PAYMENT
Charge my credit card: NAME OF CARD: ………………………………………….. CARD NUMBER: ………………………………………….. EXPIRATION DATE: …………………………………………..
Personal details of cardholder: NAME: ………………………………………….. ADDRESS: …………………………………………..
SERVICE SPECIFICATION:
AMOUNT OF PURCHASE:
Signature of cardholder: …………………………………………….
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