AMERICAN EXPRESS AUTHORIZATION

CREDIT CARD PAYMENT AUTHORIZATION

MR./MRS./MS. __________________________________________________ (As it appears on card)

(Or if payment is being made by a Company and not an Individual state name of company)

BILLING ADDRESS_________________________________________________________

 __________________________________________________________________________________

CARDHOLDERS TEL (O) ____________________________ TEL (H) _________________________

Hereby authorize AFRICAN CLASSIC ENCOUNTERS to debit my AMERICAN EXPRESS credit card

CARD # _____________________________________________________EXP. DATE: ________

for the amount of   US$___________________________________________________

I hereby acknowledge that this payment is in respect of Travel Arrangements (Transportation, Tours, Accommodation etc.) for myself and/or

_________________________________________________________________________(Full Names)

made on my behalf by AFRICAN CLASSIC ENCOUNTERS.

NAME: (Print) ____________________________________________________________________

 

CARDHOLDERS SIGNATURE: ______________________________________________________

DATE: __________________________________________________________________________

PLEASE PRINT, SIGN AND FAX THIS FORM TO  212 972 0032

FAQ