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Date _______________
Dear Sirs,
I, the undersigned, __________________________, hereby authorise GLOBAL MONEY CONSULTANTS to debit USD$_____________ (USD$ [spelled out] _______________________________________ ) from my credit card (name of card) _____________, number ________________________, expiration date ____________.
With this form, I am also providing Global Money Consultants with a photostat copy of both sides of my credit card to certify that I am the owner.
Signature ____________________________________
Telephone Number _____________________________
Mail to:
KTCGalleries.com
Galleria Center, Suite # 46, 1st
Floor,
21, A. Metaxa Street
Glyfada 16675
Athens
Greece
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Fax to:
+1-416-3525168 (Canada)
+3120-5241407 (Netherlands)
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