Name (First and Last):
Address:
Game(s) attempted to buy (specify if subscription or virtual currency):
Purchasing platform (Origin.com, EA affiliate):
Purchasing method (if CC, specify what type of card and add also the last 4 digits of the card):
Payment method owner? (If NO, complete with owner’s email, name and billing address; if YES leave empty):
New Card: Yes/No
Other successful payments online: Yes/No
Sufficient funds available: Yes/No
Check with issuing bank: Yes/No
Customer abroad from payment method issuing country: Yes/No (if yes, specify why)