| Payment Method Nickname: | {NICKNAME} |
|---|---|
| Card Number: | {CARD_NUMBER} |
| Method Type: | |
| Card Type: | {CARD_TYPE} |
| Expiration Date: | / |
| Type: | {TYPE} |
| Cardholder's Name: | {CARDHOLDER_NAME} |
| Address Line 1: | {ADDRESS1} |
| Address Line 2: | {ADDRESS2} |
| City: | {CITY} |
| State: | {STATE} |
| Zip: | {ZIP} |