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350 FIFTH AVE , SUITE 6724 , NEW YORK NY 10118 Tel: 212-695-1647 / Fax: 212-695-7756
CREDIT CARD AUTHORIZATION FORM
In lieu of my credit card imprint, I _____________________________________________
here by authorize AIR-SUPPLY TRAVEL to charge my credit card.
Circle the appropriate Credit Card : - Amex - Visa - Master -
Credit Card # _______________________________ Expiry Date (mm/yy):____/____
in the amount of US $________ . ____ for the transportation of my self and/or
Name of Passengers Traveling & their brief travel Itinerary:
Telephone # HOME: __ __ __ __ __ __ __ __ WORK : __ __ __ __ __ __ __ _
NOTE: Identification is required. Please provide Photostat copy of the credit card and
passport or driverís license of the cardholder. By signing below, I acknowledge
charges described hereon. Payment in full to be made when billed or in extended
payments in accordance with standard policy of the credit card company.
In some cases the charge may appear in two or more entries, but the total of all charges will not exceed the authorized amount. I AM AWARE THAT THIS TICKET IS VERY RESTRICTED AND NON-REFUNDABLE. PENALTIES APPLY FOR ANY VOLUNTARY CHANGES OR CANCELLATION OF TICKETS.
SIGNATURE X ___________________________
INCOMPLETE INFORMATION OR FALSE STATEMENTS SHALL BE CONSIDERED AS FRAUDULENT ACTIVITY.