AQUA SERVICES - LE LEADER DU NAUTISME
450-582-5827
EN
                                                                                                                                                               FRANÇAIS

Congratulations on your purchase to start the purchase process, please send a deposit, as discussed with your representative.
Thank you for your confidence!

AQUA SERVICES




    Purchase deposit! All these data are confidential.
    
    Renseignement Personnel
    Name:
    Family Name:
    Phone:
    Email:
    Addresse:
    City:
    Zip Code:
    Province:
    Delivery date wish:
    Name of item purchased:

    Payment
    Credit Card Number:
    Expiration Date (Month / Year):
    CVV (3 last digit):
    Payment amount:

    Consent

    I, the undersigned and certify that the above information, which will be used to study my file,
    are truthful. I hereby authorize any banking institution and / or the merchant
    AQUA SERVICES as well as their employees, agents or representatives to conduct a survey of
    solvency about me and to check my work history. I also accept that we use,
    to the extent permitted by law, the information contained in my credit file and
    use it as a history of my solvency. I admit that I was given the opportunity
    to read this consent before signing.

    I ACCEPT
    

    Initiale:

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