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Customer user information

Order  Form :

Date of Birth

Arrival Date

Expected Departure Date From Israel :  

Contact Information

Please check accuracy as the itemized bills are sent to this email address.

Customer Billing Information

Payment detail

(a statement will be sent prior to billing)

Payment Type :

Card Type :

  • We only accept Master card, Visa and Discover credit cards

 Expiration date : 

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General Comments

Authorization

Checking this box shall be deemed to be my written authorization to charge, debit or credit the credit card given, for the amount and type of transaction indicated at the time of use. I confirm that I am the credit card holder indicated above. I understand that 4 Less LLC is the billing company and will appear on my credit card statement. Furthermore, 4 Less LLC is hereby authorized to rely and act upon telephone and other electronic instructions given by me. Furthermore, I and the Student have read and agree to comply with the Terms and Conditions Statement.