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Kartes īpašnieks apstiprina apmaksu - 31.03.2010


Riga, date: …………..

 

To credit card payment we need details as follow

 Please send it by fax + 371 67222612.

 

 

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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