PAYMENT FORM FOR CREDIT CARD
其他文书-
其他文书
| 2015-04-10 09:17:22.387
I would like to make the payment for the conference by □ Visa □ Express □ Master Card （payment by Credit Cards will be charged in RMB and ____% service fee more will be charged by banks from your card）
Credit Card No.：________
Expiry Date：____________
Name on Card：___________
I consent to __________ debiting my credit card account with the amount of US$ _______ and the Bank of China is to charge ____% service fee in addition to this amount. I have also sent a clear copy of both sides of the credit card to you along with this form.
Signature：_____（should be the same with that on the card）
Date：__________
Note：__________
The payment above is made for Dr. ____________
Correspondence：____________
Ms. ____________
Tel：___________
Fax：___________
Email：_________
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