PAYMENT BY CREDIT CARD (VISA ONLY)
Please fill in, print, sign and return this form to:
Uni Computing
Thormøhlens gt. 55
N-5008 Bergen, Norway
Attn.: Edle Burgess
Or scan it and send it to: Edle.Burgess@uni.no
Or send by fax to: +47 55 58 42 95
Payment for:
ICAME material (order forms enclosed)
COLT material (order forms enclosed)
Other (order enclosed)
Shipping address:
Please charge my credit card the total sum of:
NOK
VISA Card No
Expiry Date (mmyy)
Signature:
Name in block letters:
Cardholders address:
Date:
E-mail:
