CREDIT CARD AUTHORIZATION

From: __________________________________ To: __________________________

Date: __________________________________

Reservation number:

I, ___________________________________________, hereby authorize the charge on my

credit card, type: _____________________, number:_______________________________,
expiration date: ___________, for the following charges:

(please describe your purchase order)

AMOUNT: _________________ EUR / CZK

CARDHOLDER INFORMATION:
Name: __________________________________ Address: ___________________________
Phone : ________________________________ Signature: __________________________

I understand that my credit card will be used as payment for the above charges I have
indicated.

tripex travel s.r.o., Mlýnská 326/13, Trnitá 602 00 Brno, IČO: 29267935
Vedená u Krajského soudu v Brně, v obchodním rejstříku oddíl C, vložka 69581
www.tripex.travel +421917204060