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East West Developments

Credit Card Authorization

I hereby authorize East West Developments to charge my credit card.

Amount:  US $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Please select and check below:

(     )   This is a one-time payment only.

(     )   This is a monthly installment payment.  Kindly charge the above amount every month,  (    )until the full payment is made.  OR   (     )  until 25 monthly installments only.

Credit Card is VISA/MC.    _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Credit Card number. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Expiry date:  Month _ _ _ _ _ _ _ _ _ _ _ _ _      Year _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Pin code number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Thank you.

 

(Signature) _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

My Credit Card billing info is:

Full Name_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Address_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Telephone number(s)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _  _ _ _ Fax (If any)_ _ _ _ _ _ _ _ _ _ _ _ _ _  

E-mail_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

The above payment is for Reservation Unit # _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _   OR   (      )  New.

Kindly also fax a copy of the front and back of your credit card, and a copy of your driver's license.

Please contact  info@eastwestdevelopments.com  for any clarifications.
 
 
 

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