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  •     Secure Credit Card Charge Form

    The information you submit here is 100% secure.  It will be only transmitted encrypted. Guaranteed.

    Your full name:

    The name on the card:
    (only if different from above)
    Credit card number:
    Card ID (CVV2/CVC2)
    There is no CVV2 code on the card
    Credit card expiration date:
    Credit card billing address:
    (the address where you receive this credit card's statements)
    Your telephone number:
    Is this number: home work cellular
    Alternative telephone number (optional):
    Is this number: home work cellular
    Your email address (optional):
    Your order number:
    (if you don't have your order number, make sure your name and email address are on this form)
    Amount:
    (Optional. If you know the amount of the charge)
    Comments:
    Your notes or comments about this payment (i.e. what is it for)
     

     

      By signing this form I authorize the company "1st International 8669746453" to debit my credit card the amount of US dollars for the above order.
      The prices for credits are the following:
    12 credits - $20
    60 credits - $60
    105 credits - $100
    320 credits - $300
    550 credits - $500
     

     

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