ORIENT MINIATURE PAINTING Payment Form

on EuroAsiaSingles.com NetWork

Please enter your details, fields marked with ** are required!
Business Name (if applicable):
Contact Person**:
Phone Number:
Numbers of pictures:
E-mail**: only one/double check
Delivery/Mail Address
(Address, Zip etc):

Below please enter Cardholder's Address exactly as shown on Credit Card statement!
Cardholder's Name as on card**:
Street Address**:
City+Postcode**:
Country**:
State/Province/County: Zip**: Non-USA use 99999

 

Description Price Qty.
E-mail delivery (per month) $30

allcards.jpg (13925 bytes)

Next please complete your card details on a secure server

 

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