Please
typewrite before faxing back this form to +1 530 348-7482
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Your name: |
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Contact e-mail
address: |
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VISA billing
address: |
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Country: |
Today Date: d
m
y |
Tel: number: |
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How much you
want to deposit?: |
US dollars:
maximum $ 5'000 by VISA / $ 100'000. by transfer |
Do
you want to buy funds immediately?: |
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If you buy funds
now, which one do you want? |
Fund selection
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Did
you check our fees? |
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Paying For
Your Account by VISA
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Name
on Card: |
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Card
Number: |
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Exp.
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(mm-yy) |
Any other comments:
eg any special requirements you may have
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