Zahlung per Kreditkarte English

Kontaktieren Sie unsere Reiseprofis:
07248 - 93 20 94

Authorisation for credit card deduction

Please complete this form, print it out and fax it to
(+49)/ 72 48 / 93 20 95

Name and address
of payee:
Bal-Tours GmbH
Im Gewerbegebiet 22
D-76359 Marxzell

Name and address of card holder:

surname:

first name:

street, No.:

postal code:

place:

I hereby declare myself to be agreeable with the deduction of my
credit card.

bookingnumber/invoicenumber

Deduct from my credit card (American Express, VISA, Master/Eurocard)

credit card-firm (AX, VI, MC)

credit card-number

validity of credit card (e.g. 09/2011)

CVV-number (on the back of your card - last three digits)

sum in EUR

credit card applies to
future payments

date:

Signature of credit card holder:

please sign on the hardcopy!