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Credit card data transfer

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This form is provided for our overseas customers as a secure option of submitting their credit card data for quick and easy payment.

Important: Payment by credit card is solely reserved for our overseas customers. This option is not available for customers within Germany and the EU. Please note: By using the credit card, you have to pay a additional fee of 4% from the invoice total!

Fields with a * are required fields and must be completed.



Customer no. (if available):

New customer:

First name:
*
Last name:
*
Street
house no:
* *
Postcode
town/city:
* *
Country:
*
Telephone:
(Country code) area code / telephone number
( ) / *
Fax:
(Country code) area code / fax number
( ) /
Mobile:
(Country code) area code / mobile number
( ) /

E-mail:



Type of card:
*
Credit card number:
*
Validity (Expire):
Month / Year
/ *



Comments: