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Please charge the total purchase amount to my
(
) Visa Card ( ) Master Card
Issuing Bank
: ...................................................................
a) Card Account No :.......................................
Expiry : ............. Last 3 Digits: ....................
(if applicable)
b) Cardholder’s Name or....................................................................................
Purchaser's Name
Tel : ............................................
H/P : .........................................................
Email : ............................................................................................................................. |