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AIR-SUPPLY INC.

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      

       ________________________________________________________________________

       ISSUING BANK NAME & TELEPHONE: __________________________________________

 

Name of Passengers Traveling & their brief travel Itinerary:

 

 

 

 

 

 

Telephone # HOME:  __ __ __ __ __ __ __ __                WORK :  __ __ __ __ __ __ __ _


BILLING  ADDRESS

 

 

                   

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.