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- BAD TOYS REGISTRATION FORM
- ----------------------------------------
- // This information is REQUIRED in order to process your registration //
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- Date (dd/mm/yy) ___/___/___
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- Name: ________________________________________________________
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- Address: ________________________________________________________
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- City: ________________________________________________________
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- State/Province: ________________________________________________________
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- Zip/Country: ________________________________________________________
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- Payment
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- [ ] Amount paid by cheque (takes up to 10 days to clear)
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- [ ] Money Order (please use mailing address shown below)
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- [ ] Transfer to our bank account (please use bank info shown below)
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- [ ] Credit Card (only EuroCard/MasterCard)
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- Card Number : ________ ________ ________ ________
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- Expires : ___/___
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- Exact name on card (print) : ________________________________
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- Signature(REQUIERED) : ________________________________
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- SUBTOTAL $21.00
- Shipping $04.00
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- TOTAL AMOUNT $25.00
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- Signature(REQUIERED) : ________________________________
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- Our mailing address: Our bank Account:
- -------------------- -----------------
- Valach Pavel Ceskoslovenska Obchodni Banka A.S.
- Varsavska 238 pobocka Pardubice
- 53009 Pardubice Masarykovo nam. 1458
- Czech Republic account number 20541010
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