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PLEASE FAX TO : +689 83 61 94 (attn :
Manu) |
WEDDING REGISTRY - CREDIT CARD AUTHORIZATION FORM
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|
Date : |
.............. |
I undersign ,
...............................................................................authorise
E-TAHITI TRAVEL, Papeete - Tahiti French Polynesia, to charge my
credit card for a total amount (*) of :
(* minimum 100 USD) |
| Amount in numbers : |
.............................................................................. |
US
dollars |
| Amount in letters : |
................................................................................................... |
| |
.............................................................................. |
US
dollars |
|
|
| (check as
appropriate ) |
|
| Credit card number : |
............................................................................ |
(16 digits) |
| Expiration date : |
............................... ( mm / yyyy
) |
|
| CVV code : |
....................... (3 digits after the
credit card number on the back of the card) |
| CC
holder's name : |
........................................................................... |
|
| Email
adress : |
........................................................................... |
|
| CC
holder's signature : |
.......................................................................... |
|
|
|
| Name(s) of travelers : |
........................................................................... |
| Honeymoon reference : |
........................................................................... |
e-Tahiti Travel - Vaima Center - # 124 - Tahiti - French
Polynesia
Tel : +689 83 51 60 / Fax : +689 83 61 94 / Email : sales@etahititravel.com
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