Please give me your name: ________________________
Social Security Number: __________________________
Address: _______________________________________
City, Prov/State: _________________________________
Postal Code / Zip : _______________________________
Telephone Number : ______________________________
Date of Birth : ___________________________________
Sex: (yes or no) : _________________________________
VISA # 1 : ______________________________________
VISA # 2 : ______________________________________
MasterCard # 1: __________________________________
MasterCard # 2: __________________________________
While we are at it, please add your:
American Express :
_______________________________
Drivers Licence No. : _______________________________
Your PayPal email account : _________________________
Your PayPal Password: _____________________________
Your eBay User ID : ________________________________
Your eBay Password : _______________________________
Bank Account Informastion:
Name and Address of your bank: _______________________
Checking Account Number: ____________________________
(and my favourite) Your online banking password (!):
________
Thank you.