Шиномонтажник

Описание

Share Oracle Ltd,
Registration number: 2020/IBC00012, Cnr Old and Church Street, P.O. Box 2290, Roseau, The Commonwealth of DominicaCredit Card/Debit Card Transaction Confirmation Form I,
_____ _____ ___________________________________________ __ __ ____ (“C
ustomer”) herewith
would like to
inform Shift Holdings (“Mercha nt”) about the payments made by myself with my
credit card/debit card with the following transactions:
Ca
rd t ype (mark w ith an “X”): Visa ________ MasterCard ________ Other (specify) _____________
Card h older's n ame:______________
__ __________________________________________________
Ca
rd n umber (4 l ast digits): ________________________________ ______________ ______________
Expiration d ate: _____________
___________________________________________________ _____
The li

st of transactions:
Type Amount Date and time Signature
Credit card/
Debit card
Credit card/
Debit card
Credit card/
Debit card
Date Customer’s Name and Signature