International Business Companies	Koru Corporate Services, Inc.	Corporations	BVI IBC	Belize IBC
		Hong Kong IBC	Anguilla IBC	Nevis LLC, PTC, & IBC
		UK Company	St. Kitts	Antigua
		Nominees	Resolutions	Amendments
Incorporations, Company Registration, & Corporate Contracts
P.O. Box 0816-04126, Balboa, Panama City, Panama ◊ Tel. + 507-264-3046 Fax. + 507 264-3046

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Credit Card Authorisation

Please print this form, complete it, and fax it to us at: +52-55-1084-7343. Please remember to attach the following copies: your passport, your credit card (both sides).

I hereby authorise Koru Corporate Services, Inc. to charge my credit card (details provided below) for the amount specified:

Your Contact Details:		Credit Card Details:
Surname:		Amount	$
First name:		Card Type:	Visa Mastercard
	(as on card)	Number:	(please circle) (16 digits)

Address:
(as appears on statement)
		Validation No.
		Expiration:
			(day-MM-year)
Telephone:
Passport:

Please make sure that the above details match your credit card statement.

After you have printed and completed this form, please sign below, and fax to us. Please remember to include a copy of your passport, as well as the front and back sides of the credit card.

_____________________________

(your signature should match your signature on the card)

Last edited: 04-Oct-2008

Site Features

Credit Card Authorisation

Your Contact Details:

Credit Card Details: