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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