PAYMENT FORM FOR JASMINES COPY WRITING

HERE IS MY PAYMENT INFORMATION

Please charge my: Visa ( ) Master Card ( ) Amex ( ) Debit or other credit card ( ) and name _____________________________________

Card No: ______________________________

Exp date: ______________________________ CVV date: ___________

Signature: _____________________________

MY PERSONAL INFORMATION

Name: ________________________________

Address: ______________________________

City: _________________________________

State or Province: _______________________

Postal code or Zip Code: ___________________

Phone: _______________________________

Email: ________________________________

Fax: __________________________________

  • we need your phone number or email in case we have any questions about the order.
  • all information is kept private.
  • cheques, bank drafts, money orders can be mailed to Box 314, Chalk River, Ont. K0J 2J0
Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s