Form for secure transmission of your Credit Card details › GOLF BIOMECHANIC ACADEMY by Frank Drollinger

In case you don’t want to give your Credit Card details by Phone or Fax this form gives you the opportunity to send your Credit Card details via a secure way to complete your Order or your registration for the educator program.

To execute your Order or to fix your registration for the education program please complete the fields marked with *.

First name:*
Last name:*
City:*
ZIP Code:*
Address:*
Address 2:
State / Province:*
Country:
Phone #:*
Cell Phone:
E-Mail:*
My Golfclub:
Credit Card Type:*
Credit Card #:*
Valid until:*
Security Code:*
(This is a 3 digit number above your signature on the back of your credit card, or - as on the American Express Card - it is a 4 digit number above the account number on the front side of your card.)
Conditions*
- I have read & accept the General Terms & Conditions
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