AGREEMENT
FORM
(S.O.F Credit Card Charge)
(S.O.F Credit Card Charge)
| To | : | Tamara Djaya |
| Merchant No. Visa & MC | : | |
| Merchant No. Amex | : | |
| Fax # | : | 62-361-778488 |
| Attention | : | Secretariat Committee for the Development of The Catholic Church of The Lady Of All Nations |
| Herewith I, | ||
| Name/Cardholder | : | _____________________________________________________ |
| Credit
Card type (Visa/MC) |
: | _____________________________________________________ |
| Credit Card Acct. # | : | _____________________________________________________ |
| Agree to the charges of | : | _____________________________________________________ |
| _____________________________________________________ | ||
| Written amount | : | _____________________________________________________ |
| Explanation | : | _____________________________________________________ |
| _____________________________________________________ |
Sincerely,
Date :_____________________________________________________
Cardholder signature.