Credit card payment form
If you want to fax us your
credit card details, please fill out this form and fax it to ++41 21 331 48 40
with a clear photocopy of both sides of your credit card as well
as a photocopy of your passport: Amount to be charged:
Type of card:
Cardholder's name
as on card:
Card number:
Expiration date:
Credit card billing address:
CVC2/CVV2 code:
Your name:
Date: Cardholder's signature:
I authorize Micheloud & Cie to charge my credit card. I have read, understood and approved Micheloud & Cie's business conditions including its refund policy. | 
