Credit Card

CREDIT CARD AUTHORIZATION FORM
Explanation ________________________ (PLEASE USE CAPITAL LETTERS)
Name of the person __________________________________________
Number of package P1        P2        P3        P4        P5         (Please mark the proper one)
Number of person(s) ____
Name of the cc holder __________________________________________
Total fee ________ US$  /  ________ EUR  /  _______ GBP  (Please pick suitable one)
Service will be handled by DEREN KORAY TOURISM – PsoriasisFishCure.com
Additional info __________________________________________
Card Type [  ] VISA [  ] MASTERCARD [  ]  AMERICAN EXPRESS
Card Number

__ __ __ __

__ __ __ __

__ __ __ __

__ __ __ __

Security code of the card __ __ __  The last three number of the backside
Expiry date Month ________   Year ________
AUTHORIZATION
Explanation I authorize DEREN KORAY TOURISM to charge my credit card by accepting the terms and conditions for the purpose of providing the services above
Signature ___________________________________
Current Date ______/_______/______

IMPORTANT !   >  Please fax this form to +90 232 441-0437. Thank you