3 Party Auth Form11

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Crystal Travel

WORLD-WIDE TRAVEL AGENTS


3 Party Credit / Debit Card Payment Authorisation Form
This is to authorize Crystal Travel to use my Credit/Debit Card details (as mentioned below) as deposit / full payment for travel arrangements as below. The card details below are true and correct. I confirm the credit/debit card is registered to me at the address below: Invoice No: Passenger Names: Consultant:
rd

Date of Departure: Date of return :

Destinations:

Cardholders Name: Billing Address:

Card No: Valid from Expiry Date Amount : : : Issue No: CVC No:

I agree to provide a photocopy / fax copy of both sides of my credit card for varification purpose and a copy of photo identity card.

Card Holders Signature: ________________________________________ Date: _______________________________________________ FAX BACK ON: 0207 681 3800

38 Riding House Street Fax: 0207 681 3800

Place London W1W 7ES, Tel: 0800 231 6241,

Moresand Ltd. T/A Crystal Travels Reg. in England No. 2114691 VAT No: 512659842

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