I_________________________________ of __________________________
name of agent
|
name of travel agency
|
authorize ARRANGEMENTS YUKON to have THOMAS COOK TRAVEL apply the amount
of $___________ to my client's credit card for the charges described
below, and confirm the client's/cardholder's authorization to make
these charges. I confirm that we have the client's/cardholder's signature
on file for this purpose.
Service:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
In the event of a dispute, the business named below guarantees payment
of the above amount.
| __________________________ |
______________________ |
| authorizing signature |
card number |
| ____________________________ |
____________________________ |
| title |
card type and expiration date (VISA or Mastercard
only) |
| ____________________________ |
____________________________ |
| date |
cardholder's name as appears on card |
| Agency name and address: |
Billing address for above card - this is required
by credit card company |
| ____________________________ |
____________________________ |
| ____________________________ |
____________________________ |
| ____________________________ |
____________________________ |
| Phone: ( )________________ |
Phone: ( )________________ |
| Fax: ( )__________________ |
Fax: ( )__________________ |
| Email:_____________________ |
Email:_____________________ |
Fax to ARRANGEMENTS YUKON at 867 668 7690
|