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CC Authorization Form PDF

This authorization form allows M/s Tania Travel to debit a specified amount in US dollars from the credit card of the cardholder. The cardholder provides their credit card number, expiration date, security code, name, billing address and contact information to authorize Tania Travel to make a one-time charge for the amount listed. By signing, the cardholder acknowledges that the transaction is final and irreversible.

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Elissa Naalaband
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476 views

CC Authorization Form PDF

This authorization form allows M/s Tania Travel to debit a specified amount in US dollars from the credit card of the cardholder. The cardholder provides their credit card number, expiration date, security code, name, billing address and contact information to authorize Tania Travel to make a one-time charge for the amount listed. By signing, the cardholder acknowledges that the transaction is final and irreversible.

Uploaded by

Elissa Naalaband
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Authorization Form for Credit Card

Date:

To: M/s Tania Travel


P. O Box 113-6371
Beirut, Lebanon
Tel-961-1-616 555
Fax 961-1-616 561

I, the undersigned, ------------------------------- do hereby Authorize M/S Tania Travel


to debit the below mentioned amount from my Credit Card. I also hereby acknowledge
and agree that this operation is final and no recourse can be taken against Tania Travel
as a result of this transaction.

Visa / Master

No:

3 Digit Code CVC (Card Verification Code) or CVV2 (Card Verification Value):

Date of Issue:

Date of Expiry:

Card Holder Name:

Billing Address and Tel. No:

Amount in Figures US$

Amount in Words:

Card Holder Address:


Telephone
Email
Signature & Date

Important Notice:

• Visa / Master Card will be charged additional 3% - Amex 5%


• Both sides credit card copy required.
• I.D copy for the Credit Card Holder required.
• After filling the above information, both CCAF, ID and CC copy to be sent
by fax or scanned by email.

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