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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)
(Optional. If you know the amount of the charge)
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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