Credit Card Order

I , _______________________________________________ (First Name, Last Name)

PIN Code at Fonbet, __________

Document ID _____________________________________

give permission to Fonbet Corp. to make transaction from my credit card(s) for betting deposit

Card Details:

 N   Card type   Bank-Emittent   Card holder name   Card number*)   Expire Date   Deposit sum   Authorisation Date
1 ......... .................. .................. ................ ../.... ...... ......
2 ......... .................. .................. ................ ../.... ...... ......
3 ......... .................. ................ .................. ../.... ...... ......


*) Please write 4 last digits of your card only




Date "___" _________ ____


Signature _____________________

 





















please, print and fill this form, add the copy of both sides of Credit Card (you can partially hide its number) and copy of your ID (Passport), and then fax us at +7 (495) 907-6215

For your safety it is preferred to send documents via e-mail and pack them with password. The password of this compressed file should be the username/user id of your betting account so that only authorized Fonbet staff can access your details. Please note that all your documents will be treated confidentially. Our email: admin@fonbet.com