Credit Card Authorisation Form for Agent’s Customer
CREDIT / DEBIT CARD AUTHORISACTION FORM FOR CUSTOMER CARD
I, ________________________________ , hereby authorize to charge my credit card
for an amount _______________ Currency _______
Card Details
( ) VISA
( ) MASTER
Credit Card Number __________________________
Expiration Date : _____________________________
Bank Name _________________________________
Credit Card Billing Address
Street ______________________________________
City _______________________________________
Pin Code : __________________________________
Telephone Number : ( Prefix STD Code ) ____________________
Mobile Number : _________________________________________
Passenger Name And Travel Dates:-
______________________________________________________
____________________________________________________
___________________________________________________
As the Credit Card Holder, I hereby authorize debit to my above said credit card.
CardHolder Signature _______________________________ Date : ___/ ____/____
Your Completion of this authorization form helps us to protect you, our valued customers, from credit card fraud. will keep all information entered on this form strictly confidential.
Documents required along with this Authorization Form
1. Front Copy of the Credit Card
2. Positive Photo Id Proof of card holder – Copy of PAN card, driving license, election id , passport copy ( BIO Page ), etc.
3. Latest Credit card Statement.
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