CREDIT CARD AUTHORISATION FORM

CARD HOLDERS NAME

CARD NO WITH EXPITY DATE
CARD TYPE [VISA /MASTER / AMEX]
CVV NO
PAYMENT AUTHORISING FOR
[GUESTS NAME SHOLD BE
MENTIONED]
TOTAL PAYMENT IN INR
TOTAL PAYMENT IN WORDS
CARD HOLDERS ID PROOF NO:
[PASSPORT NO / VOTER CARD NO / PAN
NO / DRIVING LICENSE NO]

To take the payment through Credit card Offline Swipe, Card holder need to provide
all the above mentioned informations along with scan copy of the credit card [both
side].

In lieu of my credit card imprint & Payment authorization, I.

hereby authorize Sarovar Portico Jalandhar to charge my above Credit Card for the
amount shown above. By signing below, I acknowledge the charges described above.

______________________

______________________
Date

Card Holder's Signature