SYAZA TRAVEL & TOURS SDN BHD

CREDIT CARD AUTHORISATION FORM FOR FAX PAYMENT
 (pre-arranged bookings only)

Please complete the form, print, sign and 
Fax to : +603-42972019

Full Name (as on card)

Email Address

Booking reference no.     
Address

Address 2

City

State / County        
Post Code

Country                  
Card Type


Visa or Mastercard only.

Bank Name :
Expiry date

MM/YY

Card Number

Security Code  (C.V.V)  
The last 3 digits of the number on your signature strip
Amount

Malaysian Ringgit (RM)
(please enter amount quoted in RM not other currencies

Please read carefullyWe can only charge cards in RM. Due to exchange rate fluctuations and
 the fact that the actual exchange rate is dictated by your card company, there may be some difference between our quoted equivalent in other currencies and what appears on your card statement. We regret that this unavoidable.
Travel by

                 No of passengers 

Flight details

Departure date 

DD/MM/YY


I, the undersigned, authorise Syaza Travel & Tours Sdn Bhd to charge my credit card with the stated amount  in Ringgit Malaysia (RM). I confirm that all information I have given is true and correct.
Signature(Please sign after printing)                 _____________________________

** Note: Please attach a photocopy of your credit card (both sides) along with this authorization form.

** Note: Amount to be charged is subject to airport taxes & fuel surchages.