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www.asianatravelmate.com

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Surname

First Names

DOB

Sex

Passport No.

Expiry Date

Special Request

1
2
3

Credit Card Authorization Form

MasterCard

Visa

Amex

Diners

Bankcard

I,.............................................................................................................., give the authorization to Asian Mate Travel co. Ltd. to charge amount of
US$..................................... from my credit card, Card Number (account No.) - - - to pay
Deposit
Balance
Insurance
Others
Expiry Date:.................(M)/......................(Y)
Card Holders Name (please print): .......................
Signature: ...................................................................................................................................................................................................
................................................................................