AUTHORITY TO CHARGE CREDIT CARD FORM
SOA no. _________

The purpose of this Authority is to enable you (the cardholder) to purchase hotel accommodation and airline tickets etc. using your credit card. We request you to photocopy and fax both sides of your Credit Card and the personal details page of your passport. Our fax machine is located in a secure area and this agreement will also be kept strictly confidential. Important! This transaction will be billed under the name of our service payment provider, Payment Processing Corporation (PPC).


To: Mr./Mrs./Ms. :
Fax Number :
Date :
Email :
Services to be rendered:
Accommodation : Php
     
Transportation : Php
     
Plus service fee : Php
   
TOTAL INVOICE AMOUNT : Php
(*** amount in words ***)    
The guest/client should provide the following information:
Full Name on Card :  
Card Number :  
Batch Code (Amex) or last 3 digits on
   the signature panel (Visa/Mastercard)		 :  
Issuing Bank :  
Expiry date :  
Date of birth :  
Credit Card Billing address (Street, City,
  Region, Postal Code, Country)		 :  
Passport Number, Place & Date of Issue: :  
 

This authorizes Visa Mastercard American Express Diners Club JCB and Filipino Travel Center to charge the Total Invoice Amount specified above to my Credit Card Account.

I hereby agree and acknowledge that the information and Invoice Amount above with Filipino Travel Center are genuine having been made and signed for as indicated above. I also hereby agree with Filipino Travel Center terms & conditions on credit card payments and policies on booking & cancellation.

Authorized by:    
    ______________________________________
Cardholder's Signature
 

Fax Check-list:

This form
Credit Card both side copy
Passport
Important! Please fax back before :
Fax No.: ++632 528-45-03 / 302 –12-09
Attention: