Lawrence Travels & Tours
Payment Options
SIGNATURE ON FILE AUTHORISATION
I
(NAME OF CARDHOLDER) _________________________ HEREBY AUTHORISE M/S
LAWRENCE TRAVELS & TOURS(P) LTD. TO CHARGE FOR GOODS & SERVICES BEING
RENDERED TO ME.
1.
NATURE OF SERVICES: Tour Services
2.
AMEX/MASTER/VISA (Tick one) CREDIT CARD NO: ___________________
3.
CARD EXPIRY DATE: ___________________
4.
PIN NO: ___________________________
5.
BILLING ADDRESS: _______________________________
6.
TEL NO:(RES) _______________
TEL NO.: (OFF) _______________
7.
MOBILE NO: _____________________________
8.
PRESENT ADDRESS: __________________________________
9.
PRESENT TELEPHONE NO(S): _______________________________
10.
AMOUNT OF CHARGE: ________________
(in words) __________
________________________________________________________
I understand that the record of Charges- in respect of goods/services received/availed-submitted
by you to my Credit Card Holder Bank will neither bear my signature nor the
imprint of my Credit Card, and I therefore,undertake to unconditionally honour
& pay without demur & contestation,the said charges, as and when I
am billed for the same by My issuer bank..
Thanking you
Yours Sincerely,
(Signature as it appears on the Credit Card)
Name: ________________
Date: ________________
Please enclose a photocopy of the front and backside of the Credit Card.
(Fax us on 91-11-23357478)
Palace
on Wheels 
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© 2003,Incredible
India Travel & Tours.
All Rights Reserved
