To the Head of the Moscow Public Foundation
support of culture and development of contemporary art
Kiseleva V.N.
От:____________________________________________________
Адрес проживания:______________________________________
______________________________________________________
Паспорт: Серия________________№_______________________
Contact phone number :____________________________
APPLICATION
Please return the money to the payment card
___________________________________________
(map name)
№
of the map:
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* |
* |
* |
* |
* |
* |
* |
* |
( Specify the number of the payment card from which the order was paid. First 6 and last 4 digits)
For paid tickets through the website
_________________________________________________________________
В сумме_______________________ (________________________________________) руб.
(Amount in words)
Транзакция №______________________Заказ №________________________
На мероприятие________________________________________________________________
(name of activity)
________________________________________________________________________________________________________
(date of event)
В связи__________________________________________________________________________________________________
(specify reason))
________________________________________________________________________________________________________
Date “______”__________________ 20_____.
Caption
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