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PAYMENT DETAILS:
Company Name
Full Nameof card holder
Credit Card Number
Expiry Date:
Security Code:
Upload Credit Card
Upload Credit Card Photo
Mandatory: Upload a Photo of Credit Card; this is for our protection to combat fraudulent orders. This will ensure you are the sole owner of the credit card being authorized for payment. We thank you for understanding our security measures placed.
BILLING DETAILS:
Name on CardFIRST AND LAST NAME:
Billing Address:
Address Line 2:
City:
State / Province / Region
ZIP / Postal Code:
Country:
Upload a Photo of valid government issued ID.upload
Upload ID
Upload a valid ID; this is for our protection to combat fraudulent orders. We thank you for understanding our security measures placed. Looking forward in doing business with you. * Please note: The name on the ID must match or correspond with the credit card used.
AUTHORIZATION:
By submitting this form, I authorize Techville Distribution to charge my card provide therein. I agree to pay for the purchase in accordance with the issuing bank card holder agreement.
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