Payment Voucher
CGFNS INTERNATIONAL * 3600 Market Street, Suite 400, Philadelphia PA 19104-2651 USA * Telephone:(215) 222-8454
** International Money Order, Certified Bank Check, or Credit Card Payments **
APPLICANT INFORMATION
My CGFNS/ICHP ID#:
CGFNS/ICHP Order Number: 2043108
Order Creation Date: AUGUST 25, 2014
Name:
Dominique
First Name
CGFNS Connect User Name: dlyanez
Lim
Yanez
Middle Name
Last Name
Date of Birth:
MAY 28, 1993
Address:
Purok 13, Bagontaas
Valencia City
City:
State/Province: Bukidnon
Philippines
Country:
Zip/Postal Code: 8709
ORDER INFORMATION
Services and Products Ordered:
CREDENTIAL EVALUATION SERVICE
$350
Amount For This Current Order (USD):
$0
Amount Due For Existing Orders (USD):
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 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 NOVEMBER 23, 2014.
Payment By:
Money Order
Certified Bank Check
Credit Card (please check one)
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.
Mail payment to: CGFNS International
3600 Market Street, Suite 400
Philadelphia, PA 19104-2651
USA
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.
CGFNS Copy
Payment Voucher
CGFNS INTERNATIONAL * 3600 Market Street, Suite 400, Philadelphia PA 19104-2651 USA * Telephone:(215) 222-8454
** International Money Order, Certified Bank Check, or Credit Card Payments **
APPLICANT INFORMATION
My CGFNS/ICHP ID#:
CGFNS/ICHP Order Number: 2043108
Order Creation Date: AUGUST 25, 2014
Name:
Dominique
First Name
CGFNS Connect User Name: dlyanez
Lim
Yanez
Middle Name
Last Name
Date of Birth: MAY 28, 1993
Address: Purok 13, Bagontaas
City: Valencia City
State/Province: Bukidnon
Country: Philippines
Zip/Postal Code: 8709
ORDER INFORMATION
Services and Products Ordered:
CREDENTIAL EVALUATION SERVICE
$350
Amount For This Current Order (USD):
$0
Amount Due For Existing Orders (USD):
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 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 NOVEMBER 23, 2014.
Keep this Applicant Copy for your records.
Applicant Copy
Payment Voucher
CGFNS INTERNATIONAL * 3600 Market Street, Suite 400, Philadelphia PA 19104-2651 USA * Telephone:(215) 222-8454
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 ID
Number (if known) and complete the cardholder information as requested.
CGFNS/ICHP Order Number: 2043108
Name of Applicant:
*Explanation of Credit Card CVV2 Number:
(To be entered below)
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
Visa and Mastercard:
This number is printed on your
MastercCard & Visa cards in the
signature area of the card.
(It is the last 3 digits AFTER the
credit card number in the
signature area of the card).
Credit Card #:
Discover/Novus
Expiration Date:
CVV2 Number
Name of Cardholder (as it appears on card):
Total Charges (see payment voucher) U.S. $
Cardholder Address: (For processing credit card payments
only. All order correspondence will be sent to the address
provided in the applicant's application/order)
Cardholder Signature (authorization for payment):
I herby authorize a charge to my credit card for the total of all
services and products ordered, including any fee
adjustments in effect as of the date the order is received.
X_______________________________________________
Signature of Authorized Cardholder
