This form is for payment using credit cards only. Please fill out all particulars below, print it out, sign it, and fax to us in Singapore at (65) 63149616. Please attach a copy of the front and back of your credit card and your passport for verification purposes.
     
Name :  
Email :  
Mailing Address :  

 
Tel (Home) :  
Tel (Office) :  
Fax :  
Card Type :            
Card Number :  
CVV Number (last 3 digit on the signature panel)  :  
Expiry Date :  
Billing Address :  

 
Item(s) Purchased : (1)
    (2)
    (3)
    (4)
    (5)
Agreed Price ($) : S$  
Add Shipping Cost ($) : S$  
Insurance Cost (2% of price) ($) : S$  
Total Amount ($) : S$  
Signature (same as behind card) :