OBOECANE.COM PRINT/FAX PAYMENT FORM

If you have submitted an order to us online, selecting the 'EMAIL ONLY' option - then please fax or post this form to us to make your payment

Your order number is on your confirmation email.

Print and POST this Payment Form to:

OboeCane.com, Grillparzerstr.56, 60320 Frankfurt, Germany.

Print and FAX this Payment Form to:

FAX NUMBER : +49-(0)69-50068844


Order Details:

ORDER NUMBER : ___________________________

(This is written at the top of your confirmation email)
Your Name: ___________________________
Date of Order: ____________________
Tel: ____________________
Fax: ____________________
Email: ____________________
DATE: ____/______/______

PAYMENT DETAILS
Card Type: _____________________________
Name on card: _____________________________
Card Number: _____________________________
Card Verification Number
(3 digits on reverse of card):		 __________
  Start Date: _____ /_____       Expiry Date: _____ /_____

Your Signature:		 _____________________________      Date: _____________