чÌÌ˚Â Ó ÔÓËÁ‚‰ÂÌÌÓÏ ÂÏÓÌÚÂ: | ‹ Ú‡ÎÓ̇ (Card #) |
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(This card is only valid when all information is filled in and the stamp is present.)
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stamp) (seller’s èêéÑÄÇñÄ èÖóÄíúÍ‚Ëڇ̈ËË: ‹
signature) (seller’s èêéÑÄÇñÄ èéÑèàëúÂÏÓÌÚ: ‚ ÔÓÒÚÛÔÎÂÌËfl чڇ
__ / (type/version) åéÑÖãú(item) àáÑÖãàÖ
òÚ‡ÏÔ‚ËÒÒ èÓ‰ÔËÒ¸
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ˆÂÌÚ‡
íÖãÖîéç | ÄÑêÖë |
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| èéäìèÄíÖãú |
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(telephone) |
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| Çˉ | ‹ |
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| чڇ |
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| чڇ | чڇ |
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| òÚ‡ÏÔ | èÓ‰ÔËÒ¸ |
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| ‡‚ÌÓÒÚË:ÌÂËÒÔ |
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| ‡‚ÌÓÒÚË:ÌÂËÒÔ | Í‚Ëڇ̈ËË: |
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| ÓÍÓ̘‡ÌËfl |
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| ‡ˆÂÌÚ |
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| ÂÏÓÌÚ‡: |
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| ÂÏÓÌÚ‡: | ÂÏÓÌÚ: |
Ô˜‡ÚË |
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| îàêåÄ | ÑÄíÄ |
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| ëÖêàâçõâ |
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| ÅõíéÇÄü |
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| ç‡ÒÚÓfl˘ËÈ |
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| ÉÄêÄçíàâçõâ |
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| - | èêéÑÄÜà | (serial |
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Ë |
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Á‡ÔÓÎÌÂÌËfl |
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‚ÒÂı |
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| purchase) | ‹ |
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| Ú‡ÎÓÌ |
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| íÄãéç |
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| ‰ÂÈÒÚ‚ËÚÂÎÂÌ |
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˂‰ÂÌÌ˚ıÔ |
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| of |
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| card) |
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| êéëëàü | ||
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| ÚÓθÍÓ |
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| ËÔ |
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‚˚¯Â |
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| ̇΢ËË |
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| _______ |
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‡Ù„ |
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