PAYMENT FORM FOR CREDIT CARD

为支付会议费用，我愿意用以下信用卡支付：□ Visa信用卡 □ 美国运通卡 □ 万事达卡（信用卡用人民币支付并且将在卡中扣除4%的手续费）

I would like to make the payment for the conference by □ Visa □ American Express  □ Master Card （payment by Credit Cards will be charged in RMB and 4% service fee more will be charged by banks from your card）

信用卡号码：                                    有效期限：

信用卡用户名：

Credit Card No.：                                                        Expiry Date：

Name on Card：

我同意从我信用卡中向CAS的国际科学交流中心支付[ ]美元，并由中国银行附加4%的手续费。我已经随信寄出我信用卡双面的清晰复印件。

I consent to the Center for International Scientific Exchanges， CAS debiting my credit card account with the amount of US$ [ ] and the Bank of China is to charge 4% service fee in addition to this amount. I have also sent a clear copy of both sides of the credit card to you along with this form.

签名： [ ] （应和信用卡上名字一致）

Signature： [ ] （should be the same with that on the card）

日期：

Date

注：

以上是由[ ]博士支付Note：

The payment above is made for Dr. [ ]

通讯地址：[ ]女士

国际科学交流中心，CAS

ICEC20秘书处

中国北京三立和路52号，邮编：100864

电话：[ ]；

传真：[ ]

电子邮件：[ ] Correspondence：

Ms. [ ] Center for International Scientific Exchanges， CAS

Secretariat of ICEC20 52

Sanlihe Rd.， Beijing 100864， China

Tel： [ ]；

Fax： [ ]

Email： [ ]