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Kosmos rent a car

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					FROM KOSMOS RENT A CAR

IN ORDER TO MAKE YOUR PAYMENT FOR THE (TO BE) PROVIDED SERVICES FROM OUR
COMPANY EASIER, WE OFFER YOU THE POSSIBILITY TO PAY BY CREDIT CARD.

TO GIVE KOSMOS RENT A CAR THE LEGITIMATE RIGHT TO TRANSFER YOUR PAYMENT TO
OUR BANK ACCOUNT, WE KINDLY ASK YOU TO
PRINT THIS AUTHORIZATION FORM,
FILL IN THE FOLLOWING PERSONAL DETAILS AND THEN
FAX THE DATA TO OUR OFFICE. (FAX NO.: 0030 22890 24981)

NAME:      ...........................................................
ADDRESS: ...........................................................
POST CODE: ...........................................................
COUNTRY: ...........................................................
TELEPHONE:...........................................................MOBILE:.......................................
FAX:       ...........................................................
E-MAIL:    ...........................................................

TYPE OF CREDIT CARD (ALL CREDIT CARDS ACCEPTED):
                             WITH NUMBER: .............................
   VISA                      CVC.............................
                             WITH NUMBER: .............................
   MASTER CARD               CVC.............................
                             WITH NUMBER: .............................
   EURO CARD                 CVC.............................
                             WITH NUMBER: .............................
   AMERICAN EXPRESS          CVC.............................


      ANY OTHER CREDIT CARD
TYPE:
...........................................    WITH NUMBER: .............................
...........................................    CVC.............................

VALID UNTIL: ...................................

THE UNDERSIGNED DECLARES HEREWITH THAT KOSMOS RENT A CAR, REPRESENTED BY
ANTONIS ROTAS, MANAGER OF KOSMOS RENT A CAR IN MYKONOS, HAS MY PERMISSION
TO TRANSFER EURO (€) ......................................... (AMOUNT) FROM MY CREDIT CARD
ACCOUNT TO HIS ACCOUNT.

DATE:                             ..................................
PLACE:                            ..................................
SIGNED:                           ..................................

				
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posted:6/28/2012
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