Embodied I-Ching

Payment Details Form

Please provide your payment details below. This information will be used to process your payments according to your agreed-upon plan.

Full Name *

Email *

Country *

Payment Method

Payment Method *

Credit Card

Bank Account

Payment Details

Card Number *

Expiry Date *

Cardholder's Name *

CVV *

BSB Number *

Account Number *

Account Holder Name *

Payment Authorization

By completing this form, you authorise us to debit your provided payment method for the agreed payment schedule. Please check the box below to confirm your permission.

I hereby authorise Wild Success to debit my payment method for the agreed payments.

Signature

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Date