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Credit Card Autorization Form - russian travel authority

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					                                          CREDIT CARDHOLDER'S AUTHORIZATION




I,                                                                            Hereby Authorize the Following Vendor:
      (Name of The Cardholder as shown on Credit Card)


      Russian Travel Authority

To Charge My Credit Card
                                                   (Card Number & Expiration Date)


CCV Security Code _________________________                               In the Amount of: ________________________

For Payment for the Following Services:




For Myself and/or
                                          (Full names of Passenger(s) if Other than the Cardholder)


My Billing Address:

Telephone Number:
                                          (Home)                                                      (Office)


Please provide copies of the Credit Card (Front & Back) and Passport or Driver's License


By signing below I acknowledge charges described hereon. Payment in full to be made when billed or in extended payments
in accordance with standard policy of the card issuing company.



X                                                                 Date:
      (Signature of The Cardholder)




                         201 North Railroad Avenue, Staten Island, NY 10304

                                      Tel 718.668.2491 Fax 718.668.1189

				
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