Himalayan Adventures Tours and Travels

CREDIT CARD AUTHORIZATION FORM

I.....................................hereby authorize Himalayan Adventures Tours and Travels to charge my Credit Card in the amount of $...................... and agree to my Credit Card company for these charges. The signature of file is valid for the payment amount authorize in this document.

Name as it appears on card : ______________________________________________

Credit Card type :

Visa

Master Card

Amex

Discover

Diners

Other

Credit Card :

CCV : _ _ _ _ _ (appears on front of AX. or on back in signature line all others) EXP : _ _ / _ _

Billing Address : __________________________________________________________

City : __________________ State : ___________________ Zip : __________________

Mailing Address : _________________________________________________________

City : ____________________ State : ___________________ Zip : ________________

Cardholder's home phone : _____________________.

BOOKING INFORMATION

Record Locator _________________ Travel Dates : __________________

Name of all passenger traveling on this card :

(Last/First) _______________________       _______________________

                _______________________       _______________________

                _______________________       _______________________

Note : Date Charges and Cancellation fee applies.

Requirement : Copy of the Credit Card front and backside and a valid Government issued ID (Driver's License).

Card Holder Signature : __________________________________