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CREDIT CARD AFFIDAVIT

I _________________________________ AUTHORIZE TRAVEL HOUSE

(NAME OF CRIDET CARD HOLDER)

TO CHARGE MY CREDIT CARD # ________________________________

CARD TYEP: VISA ( ) MASTRCARD ( )

EXPIRATION DATE _________________ AMOUNT

 IN USD___________

SERVICE ______________________________________________________

(TYPE OF SERVICE YOU BUY)

PASSPORT # DATE OF BIRTH _____________________

SIGNATURE ____________________________ DATE

_________________

PLEASE ENCLOSE A COPY OF YOUR CREDIT CARD (BOTH SIDES)

AND YOUR PASSPORT WITH YOUR SIGNITURE

FULL NAME

_____________________________________________________

BILLING ADDRESS

_______________________________________________

_______________________________________________

_______________________________________________

SIGNATURE

____________________________________________________

FOR OFFICE USE ONLY (002138000064)

Authorization No______________________

Authorization Date________________________ CVV2 ________________