CK Marketing Solutions Inc. PAYMENT FORM

In order for CK Marketing Solutions Inc. to accept and bill your credit card, please complete all fields below and submit to us.
Please provide following information as it appears in your order. All information sent is strictly confidential and CK Marketing Solutions Inc. adheres to the highest standards for account data protection.

(*Required / *の項目はすべて必須項目)

Name / お名前*

Tel / 電話番号*

E-mail Address / メールアドレス*

E-mail Address(confirm) / メールアドレス(確認)*

Company Name / 会社名または団体名*

Invoice# or Payment Info / インボイスNoまたはお支払い情報*

Amount (CAD) / お支払金額(カナダドル)*

Card Holder Name / カード所有者名*

Card Type / お支払いカード *

Card No. / カード番号*
- - -

Security Code(CVV) / セキュリティコード (カード裏面の数字3ケタ)*

Expiry Date / 有効期限*
Month:  / Year:


I hereby authorize CK Marketing Solutions Inc. to charge my Credit Card as indicated above. I take full financial responsibility should any problems arise with the credit card company.

※Payment will not be processed online. Notification of payment will be sent once it completed.