1/12/2015

Hikaribox,LightInTheBoxWesternUnion

Cmodebepagar?
ImprimaesteformularioyefecteelpagoencualquieroficinadePagoFcil:

Amount

Amount(inwords)

DONOTWRITEINTHISAREA

USD7,97

PayTo

Operator

number

Agency

Companyname

I G H T

N T H E B O X

Companycode

I G H T

N T H E B O X

H K

MoneyTransferControlNumber
Country

H o n g

K o

// Time

Date

Sender

First
name(s)

First

Lastname

City

Amount

Amount

Charge

Tax

Provence/Country

Street

Maternal

Middle

Paternal

Postalcode

Telephoneno.()()

Account

Number

ReferenceNumber

Ifyouwouldlikepaymentdirectedtoanindividualordepartment,pleasespecifyhere:

Name/Department

Totalamount
received

Identification

Type

Expiration

Customer'ssignature

Number

Agent's

signature

FSI9034(3/00)

THETERMSANDCONDITIONSONWHICHTHESERVICEISPROVIDEDARESETOUTONTHIS

PAGE:
http://www.westernunion.com/info/tnc.asp
Copyright2000WESTERNUNION

FINANCIALSERVICE,INC.

Continuar

Imprimir

https://na.gcsip.com/orb/orb?ACTION=SHOW_INSTRUCTIONS&REF=000000487800044042530000100001&MAC=2rvMs912p%2FN1MYvxcNjuVy7vfBQS

1/1