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Payment Voucher CGFNS INTERNATIONAL * 3600 Market Street, Suite 400, Philadelphia PA 19104-2651 USA * Telephone:(215) 222-8454 Dominique Lim Yanez Purok 13, Bagontaas Valencia City Philippines Bukidnon Name: First Name Middle Name Last Name Address: Services and Products Ordered: City: State/Province: Country: Mail payment to: CGFNS Inte rnatio nal 3600 Market Street, Suite 400 Philadelphia, PA 19104-2651 USA ORDER INFORMATION APPLICANT INFORMATION 8709 Zip/Postal Code: CREDENTIAL EVALUATION SERVICE Amount For This Current Order (USD): $350 My CGFNS/ICHP ID#: CGFNS/ICHP Order Number: 2043108 CGFNS Connect User Name: dlyanez Date of Birth: MAY 28, 1993 CGFNS Copy Total Amount Due On Your Applicant Account (USD): $350 Please pay the total amount due on your account. Any money submitted to CGFNS/ICHP will first be applied to any unpaid balance from previously ordered products or services before new orders are processed. Order fees must be paid in full before the application/order and applicant file is reviewed. Payment By: Money Order Credit Card (please check one) Payment must be submitted within 90 days from the day the order was created. If the total amount due is not paid in full, this order will be deleted on NOVEMBE R 23, 2014. ** International Money Order, Certified Bank Check, or Credit Card Payments ** Order Creation Date: AUGUST 25, 2014 $0 Amount Due For Existing Orders (USD): Certified Bank Check Personal checks are not accepted. Do not send cash in the mail. All fees must be paid in U.S. dollars, drawn on a U.S. bank. Please enclose this CGFNS Copy of your payment voucher with your money order, bank check, or credit card form. Remember to keep the Applicant Copy for your records. Money Orders or Certified Bank Checks must be made payable to CGFNS. Write your CGFNS/ICHP Order #(2043108) on your check Please enclose the Credit Card Payment Form if paying by Credit Card. Please do NOT mail an application form with this voucher. Application/Order information already has been submitted electronically.
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Payment VoucherCGFNS INTERNATIONAL * 3600 Market Street, Suite 400, Philadelphia PA 19104-2651 USA * Telephone:(215) 222-8454
Dominique Lim Yanez
Purok 13, Bagontaas
Valencia City
PhilippinesBukidnon
Name:
First Name Middle Name Last Name
Address:
Services and Products Ordered:
City:State/Province:Country:
Mail payment to: CGFNS International 3600 Market Street, Suite 400 Philadelphia, PA 19104-2651 USA
ORDER INFORMATION
APPLICANT INFORMATION
8709Zip/Postal Code:
CREDENTIAL EVALUATION SERVICE
Amount For This Current Order (USD): $350
My CGFNS/ICHP ID#:
CGFNS/ICHP Order Number: 2043108
CGFNS Connect User Name: dlyanez
Date of Birth: MAY 28, 1993
CGFNS Copy
Total Amount Due On Your Applicant Account (USD): $350Please pay the total amount due on your account. Any money submitted to CGFNS/ICHP will first be applied to any unpaid balance frompreviously ordered products or services before new orders are processed. Order fees must be paid in full before the application/order andapplicant file is reviewed.
Payment By: Money Order Credit Card (please check one)
Payment must be submitted within 90 days from the day the order was created. If the total amount due isnot paid in full, this order will be deleted on NOVEMBER 23, 2014.
** International Money Order, Certified Bank Check, or Credit Card Payments **
Order Creation Date: AUGUST 25, 2014
$0Amount Due For Existing Orders (USD):
Certified Bank Check
Personal checks are not accepted. Do not send cash in the mail. All fees must be paid in U.S. dollars, drawn ona U.S. bank.
Please enclose this CGFNS Copy of your payment voucher with your money order, bankcheck, or credit card form. Remember to keep the Applicant Copy for your records.Money Orders or Certified Bank Checks must be made payable to CGFNS. Write your CGFNS/ICHP Order #(2043108) on your checkPlease enclose the Credit Card Payment Form if paying by Credit Card.
Please do NOT mail an application form with this voucher. Application/Order informationalready has been submitted electronically.
-
Payment VoucherCGFNS INTERNATIONAL * 3600 Market Street, Suite 400, Philadelphia PA 19104-2651 USA * Telephone:(215) 222-8454
Applicant Copy
Dominique Lim Yanez
Purok 13, Bagontaas
Valencia City
PhilippinesBukidnon
Name:
First Name Middle Name Last Name
Address:
Services and Products Ordered:
City:State/Province:
Country:
ORDER INFORMATION
APPLICANT INFORMATION
8709Zip/Postal Code:
CREDENTIAL EVALUATION SERVICE
My CGFNS/ICHP ID#:
CGFNS/ICHP Order Number: 2043108
CGFNS Connect User Name: dlyanez
Date of Birth: MAY 28, 1993
** International Money Order, Certified Bank Check, or Credit Card Payments **
Amount For This Current Order (USD): $350
Total Amount Due On Your Applicant Account (USD): $350 $0Amount Due For Existing Orders (USD):
Please pay the total amount due on your account. Any money submitted to CGFNS/ICHP will first be applied to any unpaid balance frompreviously ordered products or services before new orders are processed. Order fees must be paid in full before the application/order andapplicant file is reviewed.
Payment must be submitted within 90 days from the day the order was created. If the total amount due isnot paid in full, this order will be deleted on NOVEMBER 23, 2014.
Order Creation Date: AUGUST 25, 2014
Keep this Applicant Copy for your records.
-
Payment VoucherCGFNS INTERNATIONAL * 3600 Market Street, Suite 400, Philadelphia PA 19104-2651 USA * Telephone:(215) 222-8454
CGFNS/ICHP Order Number: 2043108
Credit Card Payment Form:To pay by credit card, please fill in below your full name (as it appears in your application/order), and your CGFNS/ICHP Applicant IDNumber (if known) and complete the cardholder information as requested.
Name of Applicant:
CGFNS/ICHP Applicant Identification Number:
Applicant's Date of Birth:
Day Month Year
Credit Card Type (check one): CGFNS does not accept American Express
Visa MasterCard Discover/Novus
Name of Cardholder (as it appears on card):
Cardholder Address: (For processing credit card paymentsonly. All order correspondence will be sent to the addressprovided in the applicant's application/order)
Credit Card #:
Expiration Date: CVV2 Number
Total Charges (see payment voucher) U.S. $Cardholder Signature (authorization for payment):I herby authorize a charge to my credit card for the total of allservices and products ordered, including any feeadjustments in effect as of the date the order is received.
X_______________________________________________Signature of Authorized Cardholder
*Explanation of Credit Card CVV2 Number:(To be entered below)Visa and Mastercard:This number is printed on yourMastercCard & Visa cards in thesignature area of the card.(It is the last 3 digits AFTER thecredit card number in thesignature area of the card).
