Uplift Campaign | Five Talents USA

First Name

Last Name

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Address

Address 2

Postal Code

City

State / Province

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CARD PAYPAL BANK TRANSFER

Card Number

MM / YY

CVC Code

The 3-4 digits on the back of your credit card

Billing ZIP Code

Enter the Zip/Postal code for your credit card billing address

By clicking Donate, you authorise FIVE TALENTS USA to debit the bank account that you connect to for any amount owed for charges arising from your use of FIVE TALENTS USA’ services and/or purchase of products from FIVE TALENTS USA, pursuant to FIVE TALENTS USA’ website and terms, until this authorisation is revoked. You may amend or cancel this authorisation at any time by providing notice to FIVE TALENTS USA with 30 (thirty) days notice.

If you use FIVE TALENTS USA’ services or purchase additional products periodically pursuant to FIVE TALENTS USA’ terms, you authorise FIVE TALENTS USA to debit your bank account periodically. Payments that fall outside the regular debits authorised above will only be debited after your authorisation is obtained.

Bank Name

Account Type

Account Last 4

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