CREDIT CARD AUTHORIZATION FORM

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