CREDIT CARD AUTHORISATION FORM

CARD HOLDER NAME :

Organisation : M/s . AVASA HOTELS ( A UNIT OF STAMLO HOTELS LTD.)

(Merchant Name) HYDERABAD(A.P) INDIA.
to charges my card for the services rendered.

Credit Card Number :

Card Type :
Card Expiry Date :

CVV NO.

Issuing Bank :
Amount to be Charged (USD/ INR):
Card holder Address :

Residence Tel.No :
with ISD/STD code
Work Tel. No :
EMAIL :
Mobile Tel.No :

Amount of charges :
(in Indian Rupees/ USD)

I understand that this Record of charges in respect of Services Received / Availed,

Submitted by you to the Credit Card Centre / Bank will neither bear my Signatures nor
the imprint of the card and I therefore undertake unconditionally honour and pay without
any demur and conditions,the said charge mentioned above as and when I am billed for
the same.

Firther, I hereby Authorise M/s. AVASA HOTELS (A Unit of Stamlo Hotels Pvt. Ltd.) to charge my
credit Card with amount as mentioned above and have no dispute on this transaction.

Thank you,
Yours Sincerely

(Signature as it appears on the Card)

Name :
Date :

Encl.: 1) Credit Card (Visa/Master) Front & Back Xerox duly self attested
2) Copy of Photo ID Proof of the card holder which confirms card holders's nationality.
3) Copy passport all pages front and back side duly self attested.