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Western Union
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You may pay at your local Western Union branch and provide the information described below. After you have made the payment, 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): |
| Email address: |
| Confirm Email (Write email again): |
| Account Number (mandatory): |
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Recipient Information:(Information that you need to provide to the Western Union branch)
| Name: Penelope Chirstodoulou |
| City: Limassol |
| Country: Republic of Cyprus (Southern) |
| Collection Currency: Cyprus Pounds * |
* We will be able to collect money only in Cyprus Pounds. Please specify this to the Western Union branch.
Client Payment Information: (As in the receipt of Western Union)
| Sender's first name: |
| Sender's last name: |
| The 10 digit number (MTCN number): |_|_|_|_|_|_|_|_|_|_| |
| Country of payment: |
| Amount transferred: |
| Name of sales person/agent in USAGC (optional): |
To find a Western Union branch near you, check Western Union's site under "FIND AGENT LOCATION". http://www.westernunion.com/
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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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After completing all details fax this page to:
Fax: +1-202-318-4492
or
e-mail to: support5@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 must 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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