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PLEASE FAX TO : +689 83 61 94 |
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 |
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|
| |
|
| Credit card number : |
............................................................................ |
(15 digits) |
| Expiration date : |
............................... ( mm / yyyy
) |
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| CVV code : |
....................... (4 digits on the front of the card) |
| CC
holder's name : |
........................................................................... |
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| Email
adress : |
........................................................................... |
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| CC
holder's signature : |
.......................................................................... |
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| Name(s) of travelers : |
........................................................................... |
| Honeymoon reference : |
........................................................................... |
e-Tahiti Travel - Paofai building - Door BC - 3rd floor
Tel : +689 83 51 60 / Fax : +689 83 61 94 / Email : sales@etahititravel.com
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