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| Bank transfer
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You may pay via wire transfer in US Dollars or Euros. Please transfer the money to the account specified below. After you completed the paymen,t please fax this form to:1-202-318-4492.
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PLEASE WRITE VERY CLEARLY USING ONLY CAPITAL (BIG) LETTERS
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| First name: |
Last name: |
| Country: |
Phone(optional): |
| E-mail address: |
| Confirm e-mai (indicate e-mail again): |
| Account number (mandatory): |
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Beneficiary account:
| Name: USAGC ORGANIZARION LTD |
| Account number.: 179 - 11 - 085836 |
Beneficiary bank:
| MARFIN LAIKI BANK |
| Swift Code: LIKICY2N |
| IBAN: CY15-0030-0179-0000-0179-1108-5836 (Euro) |
| Address: 205 Makarios III Avenue, Victory House, CY-3030, Limassol, Cyprus |
Client payment information:
| Sender's first name: |
| Sender's last name: |
| Country of payment: |
| Amount transferred: |
| Name of sales person/agent in the USAGC (optional): |
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PLEASE WRITE VERY CLEARLY USING ONLY CAPITAL (BIG) LETTERS
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Please note that all listed prices include the extra €5 for processing and handling.
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By signing below you accept and agree to the USAGC Organization's "Terms and conditions" as published on the www.usagc.org website.
I READ, ACCEPT AND AGREE:
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| SIGNATURE |
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After completing all details fax this page to:
Fax: +1-202-318-4492
or
e-mail to:
support@usagc.org
PLEASE NOTE:
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Please make sure you have completed the payment before sending this form.
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Please note that all listed prices include the extra €5 for processing and handling. You have to send the listed amount and not add any other amount. USAGC will not return any change or refund any payment once it has been received.
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