| Country Line Invoice # | |
| Amount Paid | |
| Visa/Mastercard Number | |
| Expiration Date | |
| Name of Cardholder | |
| Signature of Cardholder | |
| Date | |
| Company name | |
|
|
|
You can download this document in the following format: PDF VisaCardPayment.pdf
Visa/Mastercard Payment
For your convenience, you may pay by Visa/Mastercard.
Please print out this form and indicate your Visa/Mastercard information via Fax
only.
On completion, please fax this form to (416) 740-4294.
Please note that 2%10 terms of payment will not apply to payments made through a Visa Card.
| Country Line Invoice # | |
| Amount Paid | |
| Visa/Mastercard Number | |
| Expiration Date | |
| Name of Cardholder | |
| Signature of Cardholder | |
| Date | |
| Company name | |
|
|
|
You can download this document in the following format: PDF VisaCardPayment.pdf
