Bank Transfer
           Payment by bank transfer should be made to the account number:
           B.I.C.: BASKESBXXX
           I.B.A.N.: ES29 2095 0589 4091 10390927
           Account number: 2095 0589 40 9110390927
           Copy of the transfer should be sent by e-mail to refractiva@vissum.com or by fax to 965 15 15 01

Credit Card ( Visa o MasterCard. We don't accept American Express)
        Please click the credit card button before entering credit card number

        I authorize my credit card to be charged the total payment on this form.

CardHolder
Nº Credit Card	Exp. Date

Please kindly send us your data if you require an invoice