| Offer
or invoice information |
|
Amount:
|
(i.e. for 145,32 enter 14532) |
| Reference
Number: |
(enter number of the invoice or the offer we sent you) |
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| Your
information |
First
Name:
(as it appears on
the card) |
|
Last Name:
(as it appears on
the card) |
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| E-mail:
|
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| Telephone:
|
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| Address:
|
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| City:
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| Postcode:
|
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| Country:
|
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| |
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| |
|
After you click on the "Make Payment" button above, you will be
redirected to
Ouroboros Payment Gateway secure pages for credit card authorization.
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