GREEN GRACE INC唯亨有限公司
Credit card by fax or mail 信用卡傳真刷卡單
本人因無法親至GREEN GRACE INC唯亨有限公司刷卡消費，特立此信用卡刷卡傳真同意書以支付下列款項 |
Name of Cardholder
持卡人姓名 |
|
Address
地 址 |
CITY: ZIP: |
TEL
電 話 |
|
Card No
卡 號 |
□□□□-□□□□-□□□□-□□□□
Three yards of the end of the back of the card卡片背面末三碼 □□□ |
Expiration date
有效期限 |
□□MONTH月／ □□YEAR年 |
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Date日期 |
____/____/____ |
Total
消費金額 |
US$ |
Credit card type
信用卡種類 |
□ VISA □ MASTER
□DISCOVERY |
Signature of cardholder
(Subject to the same credit card)
持卡人簽名
(需與信用卡相同) |
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Transaction details
交易明細 |
|
Note:
(1)Before signing, please confirm the card number, is fill in the correct amount of consumption.
(2) since the end of retention in order to query the reconciliation.
(3)Cardholder should use conventions in accordance with the credit card, a signed shall be deemed to agree to pay the full amount indicated in the card-issuing bank
I understand the above provisions of instructions.
注意事項：
-
簽名前請確認卡號、消費金額是否填寫正確。
-
請自留存底，以便於查詢對帳。
-
持卡人需依照信用卡使用約定，一經簽名即視為同意按所示之全部金額付款於發卡銀行
本人已了解以上之規定說明。
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I wish you a healthy and safe pleasant shopping
祝您 健康平安 購物愉快
GREEN GRACE INC
2360 Lomeli Ln, La Verne, CA91750
http://www.greengrace.us Tel:1-626-759-3158
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