MRSGateway

Billing Information

Language:

Client Name:

Invoice Number:

Amount:

Payment Type:

Email:

Phone Number:

Payment Information

Name of Cardholder:		Card Number:	Mastercard Visa
Expiration Date:	Month Year	CVV:

Suggested Billing Address

Address 1:		City:
Address 2:		Country:
Postal Code:

I accept the legal terms and the charges to my credit / debit card.

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Legal Terms

The undersigned CLIENT hereinafter confirms that the present transaction is being carried out pursuant to the terms and conditions set forth within the legal quote prepared by MLS ASSOCIATES and accepted on his behalf."