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Monster Media 1996 #15
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PSL.CRD
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1996-06-14
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1KB
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41 lines
NEF Credit Card Registration Form
PSL Part number 11474
*****************************************
* DO NOT SEND this form to the author ! *
*****************************************
Please read carefully Register.Doc for instructions.
Date _________________________
Cardholder's name, exactly as it appears on the credit card:
_____________________________________________________
[Company:] _____________________________________________________
Billing address for the card:
___________________________________________________________
___________________________________________________________
___________________________________________________________
Payment by: ( ) MasterCard ( ) Visa
( ) American Express ( ) Discover Card
Card #: _______________________________ Exp. Date: __________
Signature of cardholder: _______________________________________