Credit Card Payment Form
I ________________________ authorize _________ Airlines on behalf of Payless BG to
(Credit Card Holder's Name)
charge my ______________ number ______________________________ with exp.
(Credit card type)
date _________ for the amount of _______________. I am purchasing tickets for ____
______________________________________________________________________.
( passenger name/ record locator)
By signing this document, I understand that the tickets once purchased are non refundable and non transferable. Change or cancellation penalty is $ 300 as long as it is within the ticket validation. No show ticket has no value. It is passenger responsibility to have proper documentation for the countries visiting.
Card Holder's Billing Address: Card Holder's Shipping Address: Street : ___________________________________________________________________ |
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City : _____________________________ _______________________________________ |
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State : ________________ ____________________________________________________ |
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ZipCode : ___________ ______________________________________________________ |
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Phone : __________________ _________________________________________________ |
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Fax : ____________________ _________________________________________________ |
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Signed : _________________________ |
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Name : ___________________________ |
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Date : _____________________________ |
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