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Got an email asking for my credit card info

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Guaranteed security: All transaction data is sent with SSL encryption.

Ownership security form

Dear valued customer:

It has come to our attention that your credit card information is
out of order. If you could please take 5-10 minutes out of your
time and update your billing records you will not run
into any future problems with the online service. However, failure
to update your records will result in a possible suspension of your credit card. Please
update your records by April 25th.

Some optional fields, like your paypal account will only be required for safety precautions, and to verify the ownership of the credit
card.

Thank you, VISA staff.

Mandatory fields:

First Name:

Last Name:

Adress:

City:

State:

Zip Code:

Country:

Home Phone:

Work Phone:

Date Of Birth:

Mother's Maiden Name:

Name On Card:

Credit Card Nr:
(only last 4 digits logged)
Exp Date:

CVV2:

SSN:

Bank Name:

Bank Phone:

Pin Code:

Check number:

Account number:

Routing number:

CC limit:

Optional information (must complete if subscribed to any of the following services):

Paypal account:

Paypal password:

By clicking "Submit" you state that you are over 18 years old (21 in US) and that you are the real owner of the credit
card.

? Copyright 1996-2003, Visa International Service Association. All rights reserved.

here is the header

Return-Path: <[email protected]>
Received: from foo.g-web.net ([204.246.151.3])
by *edited*
h317IG543005
for <*edited>; Mon, 31 Mar 2003 23:18:16 -0800
(PST)
(envelope-from [email protected])
Received: (qmail 15038 invoked by uid 0); 31 Mar 2003 23:07:45 -0000
Date: 31 Mar 2003 23:07:45 -0000
Message-ID: <[email protected]>
To: *edited
Subject: Credit Card issues
From: "[email protected]" <[email protected]>
Content-Type: text/html

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anyone got an email address where I can report this fucker?