QSI Payment Technologies - Secure Payment Server
Merchant Name
   MAXICAB LIMO
details
American Express: You have chosen American Express as your method of payment. Please enter your card details into the form below and click "pay" to complete your purchase.

*Card Number
* Billing First and Last Name
*Expiry Date:    /    month/year
*Security Code:  
Please enter your billing address for authentication.
*Address:  
City/Town:  
State/Province:  
*Post/Zip Code:  
*Country:    
* Required field    
Purchase Amount SGD $45.00
 
I hereby authorise the debit to my American Express Account in favour of MAXICAB LIMO

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