(attachment copies of 2 sides
of the card)
My name:..........BUI
HOANG LONG...................Nationality:..............AMERICAN................
Passport number:....NB
12401225.....Date of issue:10/2005......Date
of expiry:10/2010
Address:.....102/20
Newton road, Newyork City..........................................................
Tel:................(001-5)25467895.....................Fax:........(001-5)25467895....................
Hereby authorize the following company.
Name:Sunshine Travel
Address: 42 Ma May St., Hoan Kiem Dist., Hanoi,
Vietnam.
Tel: (84-4) 9261559 Fax: (84-4)
9262643
to withdraw the amount of ....US$206......(in
letters two
hundred and three dollars only)
from my personal account by using my Credit
Card.
Card number:1324
7588 9875 5487 (16 digit
number)
SBJ code: ............ VISA.......V.........
MASTER................ Expiry date:.....10/2010..............
This amount is the payment for the following
services.
| No. |
Description |
Amount |
1.
|
- Classic 1 hotel (5 nights) |
$100 |
2.
|
- Vietnam Northern package tour |
$100 |
Bank
service charge (3%) |
$6 |
Total |
$206 |
Client's signature sample
Signature of the card
holder |
Signature of the card
holder |
Signature of the card
holder |
| |
|
|
|
Vietnam Destinations
)
