Cc Auth Form

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I send full information photo ID Credit The last 4 digits please check my
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  VULTR.com Credit Card Authorization Form Vultr.com  Account: 7plus2017@gmail.com 14 Cliffwood Ave Suite 300 NGUYEN QUANG BINH Matawan, NJ 07747 Thôn 10 xã hải xuân Phone: 973-849-0529 | Fax: 732-566-1268 HÀ NỘI VN Please attach the following information to your open support ticket for verification using the customer portal athttps://my.vultr.com/support/ 1.A copy of your government issued photo ID - driver's license, passport, etc. (Please use a camera phone or digital camera totake a photograph)2.A partial image of the card used to fund the account to ensure the provided identity matches the name printed on the card. Foryour protection, please cover all but the last 4 digits of the card. (Please use a camera phone or digital camera to take aphotograph)3.This completed form.I authorize vultr.com to bill my credit card account for subscriptions and bandwidth overage incurred under my account7plus2017@gmail.com.Account Information: NGUYEN QUANG BINHThôn 10 xã hải xuânHÀ NỘI , VN Credit Card Type (circle one):AmexDiscoverVisaMastercardCredit Card: Last 4 DigitsExp. Date (mm/yy) Owner of Account: First NameFamily Names(s) Address: StreetCityState/ProvinceZip/Postal CodeCountry/Region Phone: Fax: E-mail: Signature of Cardholder: Date: March 2, 2017NGUYEN QUANG BINH 10/21+849889436824221 0930 0090 0878 binhtiente@gmail.com0878 BINH NGUYEN QUANG DOI 10a HAI XUAN H ả i XuânMONG CAI 260000 QUANG NINH VIET NAMBình
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