Manila Forwarder Authorization Form

MANILA FORWARDERS - TRAVELPH.COM / TRAVELPHIL, INC.
CREDIT CARD AUTHORIZATION FORM

ATTENTION:
Reservations Officer : __________________________
L. A. Ca U.S. Fax No : +1 818 700-1555 Manila Philippines Telefax No. +63 2 921-7924

In lieu of my credit card imprint, I _______________________________________________, Authorize Manila Forwarders to charge my credit card (VISA, MasterCard, American Express) _______________________________________________ (account number) which expires on _________________________ the amount of _________________________ for the payment of shipping cost :

Name of Shipper: _______________________________________________________________________
Address : _______________________________________________________________________
Telephone: _____________ Cel: _______________ email : _______________________________
Name of Consignee: _______________________________________________________________________
Address_______________________________________________________________________
Telephone: _____________ Cel: _______________ email : _______________________________

NOTE: Please include CLEAR photocopies of your Goverment Issued ID. Please fax back completed form to L.A. Ca U.S. Fax: +1 818 700-1555 OR
Manila Philippines Telefax No. +63 2 921-7924. These requirements are checked by the approving bank. If you have no passport, please provide photocopies of your Driver's License or Company ID.
These are strict requirements for approval of your payment.

Credit Card Information

Name On Card : _______________________________________________________________________
Credit Card Number : _______________________________________________________________________
Issuing Bank : ________________________________________Expiry Date:___________________
Billing Address : _______________________________________________________________________
Office/Work Address : ________________________________________Zip Code: ______________________
Office/Work Tel No. / Fax No. : _______________________________________________________________________
Home Address : ________________________________________Zip Code:_______________________
Home Tel No. / Fax No: _______________________________________________________________________
Type of Card : (Please check) |__| VISA |__| MASTERCARD |__| Amexco
3-Digit ID Code: (Located at the back for VISA or MASTERCARD) : ____________________________
4-Digit Batch Code: (Located in front-right part of the card for AMEXCO) : __________________________
Passport Number : _______________________________________ Birthdate :_______________________
*Passport Number will be used as a proof of your identification as required by our approving bank.
___________________________________________________________ _____________________

_________________________________
Cardholder's Signature Date

Manila Forwarder 3964 Eagle Rock Blvd, Los Angeles, CA USA 90065 (USA Office)
Manila Forwarder Phil, Inc. (Manila Office)
#38-E Con St, Gama Compound, Rincon Rd.,
Valenzuela City, Metro-Manila, Philippines 1444