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REPORT DATE (*)

REQUEST CODE (*)

TRANSFER NO. (*)

DATE OF PAYMENT (*)

METHOD OF PAYMENT (*)
Transferencia online:
Wire transfer:
Cash:
Check:
Credit:

If you are a natural person, please indicate your customer number, or name to which the invoice will be prepared and if you are a legal person, please indicate your contract number.

CLIENT NUMBER (*)

We will collect other information of interest, from the person or place of contact, who will receive the service. After verifying your payment information.

A service invoice will be sent to the contact address.

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