Magnificent Travel
Credit Card Information Fax Form
 

Personal Particulars

Name	:  ................................................................................................................
Telephone	:  ................................................................................................................
Email	:  ................................................................................................................

Payment Particulars

Credit Card Type	VISA     MASTER
Credit Card Number	:  ................................................................................................................
Secure Number (The last 3 digit number appearing on the signature panel)	:  ................................................................................................................
Card Holder's Name	:  ................................................................................................................
Expiry Date(MM/YYYY)	:  ................................................................................................................
Remark(s)	:  ................................................................................................................
Total Amount	................................................................................................................
Card Holder's Signature	:  ................................................................................................................
Please fax the receipt to me at	.................... - ................ - ...........................    country code    area code    phone number