WBMTT INC. Credit Card Authorize Payment Form
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What is your email Address?
Full Name as it appears on the Card
First Name: *
Last Name: *
Billing Address on File with your Credit Card Company
Street Address:
Street Address Line 2
City
State/ Province
Zip Code
Country
Phone Number Associated with the Credit Card
Phone Number
Credit Card Information
Credit Card Number
Expiration Month
Expiration Year
CVV  SecurityCode. This will be the 3 digit code on the back for Visa, MC, Discover or the 4 digit code on the front of American Express.
By Initialing Below I certify that all information provided is true and accurate.
By Submitting this form I am signing with my unique IP address that I am the cardholder, authorized to make purchases on this card ad by filling out this form I am authorizing to be billed for services received.
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