Private & Confidential page 1 of 2
Payment Guarantee - Credit Card Authorization Form
After completion of this form please fax it to: 0086 28 66476366
(We only accepts Visa and MasterCard)
Intowestchina Holiday www.intowestchina.com
SICHUAN HENGXIN INT'L TRAVEL SERVICE CO., LTD INT'L TRAVEL CENTER
303# Mingyuan mansion,No. 71 Qinglong Street,Qingyang District,Chengdu, Sichuan, China.
Zip code: 610031
Your travel advisor:
From: ___________________________________________ (Name)
___________________________________________ (City, State, Zip, Country)
Intowestchina Holiday will confirm your bookings after we receive this signed & completed payment guarantee form. The deposit which is equal to 30% of the total tour cost will be drawn after your bookings are confirmed. Final payment will be drawn 30 days before departure for your China tour. (We only accept Visa and MasterCard)
To the Bank of China:
I hereby authorize SICHUAN HENGXIN INT'L TRAVEL SERVICE CO., LTD INT'L TRAVEL CENTER, to charge the amount of RMB (Which equals US$ on the date of invoice) to my Credit Card as my Deposit for my Tour to China.
I hereby authorize SICHUAN HENGXIN INT'L TRAVEL SERVICE CO., LTD INT'L TRAVEL CENTER, to charge the amount of RMB (Which equals US$ on the date of invoice) to my credit card after October 1. 2010 which is the balance owing for my tour in China.
Credit Card Type: __________________ Card Holder’s Name: __________________________
Card Holder’s Birth Date (MM/DD/YYYY): ____/____/______ Nationality: ________________
Credit Card Number: ___________________________________________CVV2 Number_____
*(3-digits at the end of your cc number in the signature line on the back of your card)
Expiration Date (MM/YYYY): ____/_______
Issuing Bank of your credit card: ___________________________________
Billing address: (If different from above)
______________________________________ (City, State, Zip)
My phone number: ______________________________
My passport number ______________
____________________________ (signature of card holder)
The Bank of China requires a legible photocopy of both sides of your credit card. Please, send the copy (page 2) with this form.
To enable us to finalize your reservation you are kindly requested to fax this completed form to us within 3 working days (or scan and email)
The receipt of your fax indicates that you have read and accept the Terms and Conditions as found at www.intowestchina.com
Copy of your credit card (front)
Copy of your credit card (back)
Please fax (or scan and email) this page with your completed Authorization form. (Page 1)
Page 2 of 2