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Text File  |  1996-02-16  |  153b  |  25 lines
  1.  
  2.  
  3. Signature
  4.  
  5. Expiration date
  6.  
  7. Card number
  8.  
  9. E-mail address
  10.  
  11. Fax
  12.  
  13. Phone
  14.  
  15. Country
  16.  
  17. City and zip code
  18.  
  19. Street and number
  20.  
  21. First name and name
  22.  
  23. Organization
  24.  
  25.