By Pixel
tours Travel Agency Manager:Anna
Vafiadou Nikos Sirigos
Main
Office Fira - Greece - Zip Code 84700
Fira
Santorini Greece
Tel: +30
22860 28115 - Fax: +30 22860 28116 (from USA please add 011 in
front) - Mob: +30 6944803339
License
Number:1144E61000026101
ΑΦΜ:109293426
IN
ORDER TO MAKE YOUR PAYMENT FOR THE PROVIDED SERVICES FROM OUR
COMPANY EASIER, WE OFFER YOU THE POSSIBILITY TO PAY BY CREDIT CARD.
TO GIVE US THE
LEGITIMATE RIGHT TO TRANSFER YOUR PAYMENT TO OUR BANK ACCOUNT, WE
KINDLY ASK YOU TO PRINT THIS AUTHORIZATION FORM,
FILL IN THE
FOLLOWING PERSONAL DETAILS AND RETURN IT TO US VIA FAX OR
EMAIL.
FILL
IN THE FOLLOWING PERSONAL DETAILS.
NAME:
ADDRESS:
................................................
POST
CODE:
................................................
COUNTRY:
................................................
TELEPHONE:
................................................
MOBILE:
................................
FAX:
................................................
E-MAIL:
................................................
TYPE OF CREDIT
CARD:
VISA
WITH NUMBER:
.............................
MASTER CARD
WITH NUMBER:
.............................
CCV NUMBER( the three last digits on the back of your
card) .......
EXPIRATION DATE:.....................
THE UNDERSIGNED DECLARES
HEREWITH THAT NIKOS SIRIGOS, HAS MY PERMISSION TO
TRANSFER ---100--- EUROS FROM MY CREDIT CARD
FOR A TOUR THAT WILL TAKE PLACE ON:
