You can pay by credit card as bellows .
Authorisation Letter
( Required Attachment copies of sides of card and the 1st page of your passport )
- My name : …………………………..
- Nationality : …………………………..
- Passport number : …………… Date of issue ..... ............. .................. Date of expire ...............................................
- Address : ........................... ...... ........... ..... …………………………………………………………………….
- Tel No
: ................................................. ......... Fax No
............................ ...........................
..................………………………..
- Email Add :
- Accompany with : ……………… …………… ……………… …………………………………………………………………….
Hereby authorise the following company :
- Company name : Customized Tour Co,ltd.
- Address : 22 Bao Khanh, Hoan Kiem Dist, Hanoi -
- Tel : + (84 4) 9289308 Fax : + (84 4) 9289764
- To withdraw the amount of $US …………………….. ( Total in words …………… ……………… ………….. ………………………………… ) from my personal bank account by using my Credit card.
Cards numbers :
CVV/CVC code
Expire date
This amount is the payment for the following services :
|
No
|
Descriptions
|
Amount
|
|
|
|
|
|
|
Tour Service charge of 3 %
|
|
|
Total
|
|
|
Kindly acknowledge your acceptance to settle the above - mentioned amount by signing three times and returning the application.
|
Signature 1 :
|
Signature 2 :
|
Signature 3 :
|
|
Cambodia Tour
