Credit Card Off-Line/Fax Payment Form

TatukGIS Sp. z o. o.
Plac Kaszubski 8/105
81-350 Gdynia Poland
Fax : +48 (58) 621 09 62

Country:

Date:


Please charge the credit card based on pro-forma invoice number  for the total amount of .

Credit card 

 

Owner 

Number

Expire End

Year:      Month:

Billing Address

Signature


If you make a mistake while filling in this form, go to the link under “Bank Information” at http://www.tatukgis.com/contacts/contacts.aspx to access a new form. The striking out of mistakes will not be accepted by the credit card processor.
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