Credit
Card Authorization Form
******************* |
Cardholder's
Name:____________________________________________________
Home
Address:________________________________________________________
Country:_______________________
Zip Code:________________
I hereby authorize Dragon Travel to debit :
Amount (USD): (____________________________________)
Amount in Word:_______________________________________________(USD)
against my Credit Card , details of which are listed below :
Visa Card ( ) Master
Card ( )
Card Number: (_______________________________), Expire on:(____________)
Month/
Year
| For
Services:________________________________________________________
________________________________________________________ |
Signature of Cardholder:_____________________
Date:_____________________
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