DIECAST NEWS

Payment form for Awesomely Terrific 1:53 Labor Day 2012 Promotion

 

Awesomely Terrific 1:53  Promotion Credit Card Authorization Form – Tonkin Replicas, Inc.  Good August 31th 2012 to September 4th 2012    (Please read Provisos for complete dates of Promotion)

 

Credit Card Info

Credit Card Type:  Visa___ MC____Amex_____ Discover_____

Name on the card_________________________________________

Phone Number of Card Holder _________________

__________________________________________________

Account Number__________________________________________

Expiration Date____________________

VCode__________________________

Street Address associated with card

 

 

Zip Code associated with card__________________

Email Address- so we can email tracking number and copy of invoice

__________________________________________________________

 Amount $40.00 (Total price for participants in Continental US)