2:Name Ordered

3:Zip Code

4:Address

5:Phone Number

6:E-Mail

7:Payment Method

7-1:Card Name
1.Visa Card 2.Dinners Card 3.Masters Card 4.Million Card 5.Nicos Card

7-2:Card Number
7-3:Real Owner
7-4:Expiry Date (Month&Year)

***Please fill in the form if the recipient or the destination is different.

9:Recipient

10:Zip Code2

11:Address2

12:Phone Number2

13:Comment

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