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Nemesysco's
Order Center To:
Nemesysco's Order Center - Nemesysco
Ltd. (By
Fax: +972-9-885-3782) I would like to order the following:
Total Order Value: $_____________ (Please Fill the Total Sum) Please charge the "Total Order Value" with the credit card details provide hereinafter: Credit Card Info: Credit Card Owner Name: ______________________ [ ] Visa [ ] Master Card [ ] American Express [ ] Credit Card
Number:______________________ Valid: ________ CVV2 Code: _______ Credit Card owner ZIP code: ___________ (as known to the credit card Co.) Please apply this Discount Code (Coupon Code): ___________ Shipment
Address: Please deliver the shipment to the following address: <Please fill>________________________________________________________________ __________________________________________________________________________ ZIP Code __________________________e-Mail___________________________________ My Phone Number: _______________________ Fax (Optional): _____________________ Credit Card Holder Signature: ___________________ Date:_______________________ Please
Print this form, fill the details, sign it and fax it to:
+972-9-885-3782 Our support
is available at +972-9-885-3864 (GMT +2)
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