(please write legibly if you fill this form by hand)
Name on card___________________________ Signature: ____________
*I accept personal or company checks in USD, GBP, FRF and BEF. Eurocheques must be in BEF to avoid high bank charges.All other forms of checks incur high bank charges. If you must use them, please add the equivalent of US$15 for processing.
You can check the latest currency exchange rates on the Web at: http://www.xe.net/currency/