Ars Polona S.A.ul. Obroncow 25
|
|
|
The following credit cards are accepted: VISA, DINERS CLUB, MASTER CARD. If payment by credit card , placing an order, put the following data, please: |
|
|
I will pay by Credit Card for ordered goods: |
|
|
Kind of card (one of above mentioned) |
... |
|
|
Credit Card number |
... |
|
| Country of Origin of card |
... |
|
|
Expiry date |
... |
|
|
Name on the card |
... |
|
|
Buyer address |
Home address: |
... |
| Address for bank: |
... |
|
|
Kind of order |
... |
|
|
Value of order |
... |
|
|
Date ............................................... |
Signature ............................................ |