The
Linguaviva Centre Ltd.
For your security, do not e-mail this document,
please fax to:
+353-1-6765687
Payment
by Credit Card
I _______________________________ hereby authorise you to charge to my credit
First Name & Surname
card (details below) the following amount: EUR (€) ________ and I attach a photocopy of the front and
back of my credit card.
Signed ____________________________________ Date ___________________
Signature
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Credit Card Information: Visa r Mastercard
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For your safety, this document should be faxed and not sent by email.
Our fax number: +353-1-6765687