DATE : ____________________
ESCO LEASING PTE LTD
278 RIVER VALLEY ROAD SINGAPORE 238319
Download this form via Acrobat PDF
DATE : ____________________ ESCO LEASING PTE LTD 278 RIVER VALLEY ROAD SINGAPORE 238319
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Download this form via Acrobat PDF
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RE: CREDIT CARD AUTHORISATION
| FULL NAME |
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| MAILING ADDRESS |
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| EMAIL ADDRESS |
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| TELEPHONE NUMBER |
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| FAX NUMBER |
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| I ______________________________ (Full Name) on this __________ day of _______________ 20____, do hereby irrevocably authorise Esco Leasing Private Limited to debit my American Express credit card with the amount of S$____________________ being payment made for _____________________________. |
| NAME (AS PRINTED ON CARD) |
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| CREDIT CARD NUMBER |
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| CARD ISSUING BANK |
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| EXPIRY DATE |
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Sincerely yours,
__________________________________________ (Signature as on card) *Please download and print out, fill up in block letters and email to us : |