PSI Credit Card Application
Paul Scherrer Institut
www.psi.ch 
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Credit Card Data

If you would like to pay into the account of "NameOfConference" please fill in the following form completely (all information will be encrypted):
Remark: This is a secure connection. All data is encrypted. We recommend after submission that you empty your browser cache.

Amount:
Currency: Swiss Francs
Euro
Pay by: Visa
Eurocard/Mastercard
American Express
Card Number:
Expiration date:
Card verification value
(last three numbers on the back of the card):
Cardholder´s name:
Street/Number:
Town:
Country:
Company/University/Institute's name:

Participiant name(s), mandatory only if
  • cardholder's name is not the same as the participiant's name
  • payment is to be made for several participants of the same organization

 
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