CC Autho form (PDF)

VK Travels
AUTHORIZATION FORM
I __________________________________________ hereby authorize VK Travels to charge my Credit Card / Debit Card for travel
purpose.
Card No. : _______________________________ ¾ digit security code from back of card: ________
(3 digit for Visa/ MasterCard from back of card – 4 digits for Amex from front of card)
Card Type: Master Card / Visa / American Express (Circle One)
Expire Date: __________________________ Amount in USD: ____________________________
Bank of Issue: ____________________________________
Customer Service phone no from back of credit card: _____________________________
Driving License No.: _____________________

State of Issuance: ______________________

Card Holder’s Name: ______________________________
Billing Address: __________________________________
___________________________________
E-Mail Address:

___________________________________

Best US Mobile Phone: _____________________________ Fax: _________________________
Best India Contact nos. : __________________________________
Is the Card Holder travelling?

YES

NO

I _____________________ (card holder) agree to pay the travel expenses for _________________ (name of person traveling) with
my credit card, details of which are listed above.

I understand the Refund / Cancellation penalties that have been explained to me relating to this type of
purchase and will be applicable and acceptable to me.

PLEASE FAX THIS COMPLETED FORM WITH CREDIT CARD FRONT AND BACK
AND A COPY OF PICTURE ID TO 1-510-573-5057 or SCAN AND EMAIL IT BACK
TO vktravels@vktravels.us
_______________________________

_______________________

Signature of Card Holder

Date
41446 Beatrice St.,

PHONE

1-510-573-4153

Fremont, CA 94539

FAX

1-510-573-5057

EMAIL
WEBSITE
1

vktravels@vktravels.us
www.vktravels.us