ONLINE PAYMENT FORM

To initiate the payment procedure, please fill out the fields below. For security purposes, your IP address of 100.24.118.144 will be recorded. After completing the form, clicking the button will allow you to review your payment and complete the transaction.

Reference Number (see you confirmation mail):
Amount to pay (No decimal numbers):	USD
CREDIT CARD INFORMATION
Credit card number:
Select Credit Card Type:
Expiration date:	Month: Year:
Security code: What is this? :
Name on the card:
BILLING ADDRESS
Address Line 1:
Address Line 2 (optional):
City:	State:
Zip Code:
Country:
Telephone:
Email:

Payments and cancellation policy.