LEXIA Payments

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Client details:

First name

Last name

Email address

Insert Amount (Euros)

Country

City

State

Postal code

Address

Phone

Card data:

Name on card

Card Number

Expiry Month (Example: 01)

Expiry Year (Example: 2028)

CVV (Example: 123)

Invoice details (not required):

Company name

Invoice number

Vat number

Change payment method