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Published by Jeunesse School, 2017-02-28 03:52:28

付款授权书

付款授权书

付款授权书

(请完成填写以下表格并在上面签署姓名,请将此表格发到香港公司邮箱:[email protected]
赋予持证人身份证的照片及信用卡的正面和背面的副本的复印件)

信用卡持有人的名称_______________________________________________________________
账单地址_________________________________________________________________________
_____________________________________________国家_____________邮编_______________
信用卡/银行卡发行名称_________________________________城市____________国家_______
(如适用)订单邮件地址______________________________________________________________
_________________________收货人姓名____________________电话________________________
订单应付金额美元$_______________
付款方式(一)︰□电子货币包 / □金币 奖金持有人网站 URL︰________________
付款方式(二)︰信用卡类型□Visa □Master Card □American Express
信用卡号码______________________________________________________________
到期日_______/_______CVV 安全码______________

订单号码# / 套餐名称 用户名/网站 URL URL 用户身分证号码#
(如适用)

如上所述我对这些账户支付负全部责任,无论产品是否运到我的账单地址或收件人
经销商的地址,将遵循Jeunesse Global相关的所有政策和程序。

持卡人签名︰___________________________
日期︰_______/ _ _/


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