PURCHASE AGREEMENT FORM

ATTENTION: CIRRUS UK CASINO - ACCOUNTING DEPARTMENT
Toll Free UK Fax Number: +44.207.990.8100
Send scanned copies to: support@cirruscasino.co.uk


I, _____________________________<name as shown on the credit card>, of legal

age, resident of ______________________________________________________

____________ (address), and card holder of

Card number: ______________________________ and expiration date ____/____

Card number: ______________________________ and expiration date ____/____

Card number: ______________________________ and expiration date ____/____

Card number: ______________________________ and expiration date ____/____

do understood and hereby authorized the charges made to Cirrus UK Casino.

I hereby declared that I am the legitimate owner of the above-mentioned credit card.

I acknowledge this purchase(s) and agree that all sales are final. I acknowledge that I have read the entire agreement and understand that I will be held fully responsible for its terms and charges and I agree not to chargeback as long as I receive the services that are defined within the terms of agreement.

For verification purposes, I have attached the copy of my driver|s license, back and front copy of the credit card used.

I also agree that any changes on my account information, I will be sending this form again together with the changes in my account.

I hereby acknowledge that all information I have provided are true.

I am also aware that the transactions will show as "AQUAPAY, LONDON" on your credit card statement.



SIGNATURE: ____________________________    Date: ____________________

FOR FUTURE PURCHASE using credit card(s) mentioned above:
(please choose one)

____ As the credit card holder, I also authorize Cirrus Casino to charge my credit card for future purchases verbally or electronically approved by me.

Authorization valid until _____/_____

Signature/Initials: ______________

____ I will send this form again. Cirrus UK Casino can ask again for any other purchases.