LIRITA TOURS TOURISM & TRAVEL AGENCY
CREDIT CARD PAYMENT AUTHORIZATION
I,
authorize Lirita Tours Tourism & Travel Agency , Istiklal cad. Hamam sok. No: 9 ÜRGÜP 50400 Turkey. | ||||||
to charge the sum of : |
(please indicate currency) | |||||
(in letters ) | ||||||
| ||||||
Card Number : | ||||||
Please advise the last three-digit number appearing on signature panel: | ||||||
Expiry Date : | ||||||
My name as appear on the card is : | ||||||
The above mentioned charge is for : | ||||||
Card Holder’s Signature and Date: | _________________________ | |||||
Cardholder's Passport Number: | ||||||
Cardholder's Address : | ||||||
Cardholder's Tel. No : | Country Code No | |||||
Cardholder's Fax No : | Country Code No | |||||
KINDLY FILL OUT THIS
FORM ALONG WITH YOUR SIGNATURE, PRINT OUT AND FAX BACK TO LIRITA TOURS |