PLEASE INPUT SETTLEMENT INFORMATION *IS REQUIRED
NAME *
PLEASE INPUT YOUR FULL NAME.
ZIP *
PLEASE OMIT HYPHEN "-". (NUMERIC)
CAPITAL *
PLEASE SELECT PREFECTURE.
ADDRESS *
PLEASE INPUT THE ADDRESS.
PLEASE INPUT THE NAME OF BUILDING OR APARTMENT.
TEL *
PLEASE OMIT HYPHEN "-". (NUMERIC)
EMAIL ADDRESS *
(ALPHANUMERIC)
NOTE
     
CARD IS AVAILABLE IF ANY OF THESE MARKS ARE ATTACHED.
AMOUNT 70,000 yen
CARDHOLDER'S NAME*
CARDHOLDER'S NAME ON THE CARD.(ALPHANUMERIC)
CARD NO*
PLEASE INPUT 14-16 DIGIT NUMBER WITHOUT HYPHEN "-" AND SPACE
EXPIRATION DATE*  / 
PLEASE INPUT MONTH AND YEAR (MM/YYYY)
CARD CVV2 *
THE LAST THREE OR FOUR DIGIT NUMBER ON BACK SIDE OF THE CARD
This credit card payment system is provided by Maxconnect Singapore.
PLEASE INPUT PERSONAL INFORMATION AFTER CONFIRM PRIVACY POLICY OF OUR COMPANY.

FOR ANY INQUIRY
CREDIT CARD SUPPORT CENTER
 Tel: 03-6826-5621 (WEEKDAYS: 10:00-20:00)
 Tel:+65-6829-2340 (WEEKDAYS: 10:00-20:00)
INQUIRY E-MAIL ADDRESS
 info@max-c-e.com










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