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Fax or Mail Credit card Form |
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Fets Fash Media |
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C. Günthel & M. Hoennicke GbR |
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Tulpenstrasse 1 |
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D-95186 Höchstädt |
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Fax: 0049-8031-288144 |
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Mail: Info at fets-fash.biz Konto: 5 106 486 BLZ: 711 601 61 Raiffeisenbank Rosenheim |
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Membership for the follow sites: |
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Homepages |
1 Month |
3 Months |
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www.Sexflexvideo.com |
€ 19,95_____ | € 49,95_____ | ||
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Name: |
Family Name: |
Street: |
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!!!! e-mail !!! |
Town: |
Country: |
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@ |
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Possible Cards: Eurocard, Visa, Mastercard |
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| Creditcard - Number: |
Expiration Date: |
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______ ______ ______ ______ |
Month: ___ Year:____ | |||
| . | I send money in a letter: | ______ € ______ | Dollar US$ | |
| . | I send a cheque (or postal money) order | ______€ ______ | Dollar US$ + 15,- € or 12,- US$ bank fee | |
| Date for beginning the membership: | Signature: | |||
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Bitte drucken Sie dieses Formular aus und faxen es an obige Nummer. |
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Please, print this form and fax it to above number. |
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