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IMPERIAL FINANCE GROUP

CREDIT CARD VERIFICATION FORM

With this Deposit Statement I, Josip Matanovic (customer) am authorizing


Imperial Finance Group to charge my credit card with the following transactions

Card type (mark with an x): Visa MasterCard X Other

Card holder's name: Josip Matanovic

Card number (4 last digits): 6973

Expiry date: 09/21

Email (client): jmatan81@gmail.com

The Following Transactions:

Type Amount Date and Time Signature

Credit card 100€ 20.01.2020 17:17:29

Credit card

Credit card

Credit card

Credit card

Credit card

Credit card

Date Signature
20.01.2020

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