Info LondresCredit card authorization form

DETAILS OF PAYMENT
  Name of cardholder:
  Surname of cardholder:
  Address of cardholder:
  Home telephone:
  Type of card:
  Card number:
  Start date
/
  Expiry date:
/
  Security number:
 Security number is the three digit number on the back of the card
  Product:
  Amount:
PERSONAL DETAILS
  Name:
  Surname:
  Date of birth:
     19
  Address:
  Post code:
  City:
  Country:
  Home telephone:
  Mobile:
  E-mail:
  Please insert the name
  of the other partecipants:
Uk London ServicesSecure site form: any payment will not be debited automatically but will be sent by email to Info Londres account department that will check the credit card details and proceed with the payment.
  Confermo di aver preso visione e accettato i Termini e le condizioni

 

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