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Cardholder s name authorize INPT to charge my credit card - VISA EUROCARD ou MASTERCARD no American Express - N. - expiration date / month/year - cryptogram 3 last figures at the back of the card - for the amount of euros Signature Bank information Organism Institut national Polytechnique de Toulouse SIRET 19311381800127 Code NAF APE 8542 Z Enseignement Sup rieur VAT Number FR42193113818 Bank account Bank address Tr sorerie G n rale - Place Occitane - 31029 Toulouse Cedex FRANCE...
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