Hand Credit Card Form

THE FORM MUST BE FILLED BY THE CARD HOLDER "ONLY".
DETAILS OF THE CARD HOLDER
Name of cardholder:
Surname of cardholder:
Address of cardholder:
Home telephone:
Type of card:
Card number:
Expiry date:
Security number:
Product:
Amount:
DETAILS OF THE CLIENT
Name:
Surname:
Date of birth:
Address:
Post code:
City:
Country:
Home telephone:
Mobile:
E-mail:
Please insert the name and date of birth of the other partecipants:




Important! I have read and accept Uk London Sevices Ltd terms and conditions and I will advise all other partecipants as part of this reservation of these conditions.
Date: _____________ Signature of the card holder: ________________