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(in letters) |
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TO:
Visa
 Master Card
 Amex
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| Card Number
:
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Four digits on right hand corner (Amex only) :
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| Three digits
on back of card (Visa or Master only) :
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Expiry Date (mm/yy):
/
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My name as appear on the card is :
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Card Holder’s Billing
Address:
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The above mentioned charge is for :
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Card Holder’s Signature :
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_________________________ |
| Date (dd/mm/yy): |
/
/
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| Cardholder's Passport
No : |
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| Cardholder's Fax No : |
Country Code
No
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KINDLY FILL OUT THIS FORM ALONG WITH YOUR SIGNATURE,
PRINT OUT AND FAX BACK TOGETHER WITH PHOTOCOPIES OF YOUR CREDIT
CARD (front and back) AND PASSPORT TO (66-2) 881-1019
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