|
To:
Fax:
001 916 4195257
( Please print this form and then fax.)
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 15 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
call 001 916 4199591 or contact ewdev@aol.com
for any clarifications. |
