TWEPP 2007 Credit card payment form

for

I hereby authorise you to charge my credit card with the ammount:
* the last 3 small digits printed near your signature on the reverse side of the credit card
Name and address of the cardholder: .........................................................
.....................................................................................................................................
Credit card No:.............................................................Expiry date:.................................
 
Cardholder's signature............................................................


Please print, fill in and send this form via fax to the AMCA, spol.s.r.o.
Fax number: +420 257 007 622
phone number: +420 257 007 629
email: twepp@amca.cz