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I authorize Waterbrid Parakites to deduct £ from the following card:

Card Type*
Card Number:*
Valid from* (dd/mm/yy)
Expiry date:* (dd/mm/yy)
Issue Number; (Switch Only)
Security Code:* (last 3 numbers on the reverse of the card)
Name on Card:*
Full Address of card holder*
NB. If goods are being delivered to an address that is not the cardholder's address please complete the declaration below.
 
I authorize the goods to be shipped to the following address:
Name:
Date:*