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Payment
[ ]Credit card [ ] T/T [ ]Check/Money Order [ ]Paypal [ ]Western Union [
]Moneygram
Credit card information
Card Number: ______________________________ Expire Date (month/year)
__________
Card Holder Name: _________________________ Verify Code (CVV):
_________________
Billing address:
______________________________________________________________
City: ___________ State: _________ Country: __________
Zip code: ___________
I hereby order the above CD and authorize the
charge_________________________ ______
Signature, Date
You can also mail this form as well as your payment to:
INTBIT INC, PO BOX 2502 ROCKVILLE MD 20847 USA |