It completes the following form with the asked for information so that we can identify his payment and credit it to his account

Line
Full name:

E-mail:

Telephone:

City:

Province:

Bank where it paid:

Branch:

Deposited exact amount:

Ticket Number:

Paid plan:

Others (to specify):

Paid dominion:

Date of payment:


Additional information, consultations or suggestions:



Mesa de Ayuda