Notification of Bank deposit, PAYPAL or Pago de Proveedores

“This form is ONLY for in cash notifying a deposit, check, Paypal or if you used the system of payment of suppliers from your bank�?

If you did a transference please uses this link to confirm its payment.

Domain that it has bound to the plan of hosting:
*

(*) Its domain is the name of its webpage (ex: midominio.cl) or what follows @ in its mail (ex: [email protected])

Information of Payment

Full name of the Holder of the account or depositor:
*

Type on watch whom he cancels:
*

Telephone of Contact:
*

Email of Contact: *

Amount of the Deposit (weights - without points):
$ *

Type of Payment:
*

Bank of Origin:

Banking branch:
*

Date of the Deposit:
/ / *

Hour of the Deposit:
*

Commentaries:

Data for the emission of its Factura:

Email for shipment of Invoice: *

Rut de Facturación (ex: 15664444-5):
*

Direction of Invoicing:
*

City:
*

Commune:
*

Turn (máx. 39 caract.)
*

Trade name (máx. 39 caract.)
*

Immediate activation

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