Order Form

noodleproudSoftware and s/w Development

Oct 29, 2013 (3 years and 7 months ago)

69 views


Q
-
TELCO

Fax (EU): +4112742999

Fax (USA): +1
-
702
-
995
-
6828


Order Form


1. Pay To: Q
-
TELCO. 2. Payment For:
Q
-
TELCO CallBack Card.

3. Quantity:
1



4. Amount: $100
USD One Hundred Only.


Print Your Credit Card Information.. Your information will be ke
pt secure and private.



5. First Name: ____________________ 6. Last Name: ____________________



7. Credit Card Number: _____________________


8. Type:__________



9. Card Verification Number: _______

10. Expiration Date: ____/____


Billing Addres
s (where you receive your credit card bills):


11. Street: ___________________


12. City: ____________________

13. State/Province: ____________


14. Zip: _____________________

15. Country: _________________


16. Telephone: _______________


For call return
:


17. Email Address: ____________


18. GSM Phone:______________





For your protection, we confirm credit card billing addresses. The process normally takes about 5
business days, but it may take longer during certain days of week. CallBack cards can N
OT be returned
and amount is NOT refundable!





Signature: ______________________

Date: _________________



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