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1.SIGNATURE ON FILE sent thru FAX for MASTER/VISA only(valid for single transaction only)
*Please "print form" and fill the payment form below, SIGN and then fax it to my
New York # 212-202-4237
*This number is efax; it encodes the fax automatically and jumps to my email in Bombay.
*Please fill the letter with BLACK INK only. *Point # 6 (in the Payment form) is the amount in Rupees/$ which we will confirm after your purchase.
1. Date:
_________ Sub: Card debit for payment. Please accept the payment towards my purchase from you 2. Master/Visa Card No.:_____________________________________________ 3. Name: __________________________________________________________ 4. Date of expiry: ___________________________________________________ 5. Address: ________________________________________________________ __________________________________________________________________
(In Words _________________________________________________________ Thanking
you,
=========================================================== If you have any
queries, please let us know. abakhru@hotmail.com
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