MANILA FORWARDERS / TRAVELPH
  US Address:
4249 Eagle Rock Blvd, Los Angeles CA 90065
Tel: 323-4781599 Fax: 323-4781165
Email: sales@manilaforwarder.com
Yahoo Messenger: manilaforwarder_1

Philippine Address:
#5, Alpha St., 1st Malinta Industrial Park, Barangay Rincon,
Valenzuela City, Philippines
Tel: 579-45-56, 579-45-57 Fax: 921-79-24 US No: 323-2479547
PH Text No: +63999-6778902 US Txt No: 213-4944175
Email: info@travelph.com | manilaoffice@manilaforwarder.com
Yahoo Messenger: travelph_livehelper & travelph_livehelper2

  
   
   

CREDIT CARD AUTHORIZATION FORM
 

In lieu of my credit card imprint, I _________________________________________ authorize

Manila Forwarder Group to charge the amount of _______________ to my credit card for the payment of:


_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________
 
 
    • These are strict requirements for approval of your payment.
    • Please include a copy of your passport or any valid ID (Company ID, Driver's License or State ID).
    • Please fax back completed form to 323-4781165(US) or 632-2439459(PH).
    • There is a 3% surcharge for credit card payments.
  
 
 
Name on Card: ______________________________________________________
Credit Card Number: ______________________________________________________
Expiration Date: ______________________________________________________
Issuing Bank: ______________________________________________________
Billing Address: ______________________________________________________
Home Address: ______________________________________________________
Home Tel No: ______________________________________________________
Fax No: ______________________________________________________
Work Address: ______________________________________________________
Work Tel No: ______________________________________________________
Fax No: ______________________________________________________
Type of Card (Visa, Mastercard, Amex): _______________________________________
Last 3 digit (Located at the back for VISA or MASTERCARD): _____________________
4-Digit (Located in front-right part of the card for AMEX): __________________________
Passport/ID No: ______________________________________________________
 
 

    ____________________________                                          __________________
           Cardholder's Signature                                                                      Date