| Booking Number (s): |
__________________________________________________ |
Record Locator (s): |
__________________________________________________ |
Carrier/Airline Name (s): |
__________________________________________________ |
|
Passenger Name (s) : |
Adult { 1 } |
__________________________________________________ |
Adult { 2 } |
__________________________________________________ |
Adult / Child { 3 } |
__________________________________________________ |
Adult / Child { 4 } |
__________________________________________________ |
Child / Infant{ 5 } |
__________________________________________________ |
|
Credit Card Type:
{ } American Express { } Master Card {
} VISA Card { } Discover Card |
Cardholder's Name : |
_________________________________________________ |
Credit Card Number : |
_________________________________________________ |
Exp. Date(MM/YY) : |
________________________CVV2: ___________________ |
Amount Charged : |
$ ________________________________________________ |
Cardholder's Billing Address : ______________________________________________ |
City : __________________________ State :
________________ ZIP :______________ |
Phone Number : ___________________ Billing Phone
Number:___________________ |
E-Mail Address: |
_________________________________________________ |
Phone Number of Credit Card Company
for Verification : ________________________ |
| |
| Note : Identification is required. Please provide Photo copy of the
credit card (front and back) and
Passport or driver's license of cardholder. |
|
By signing below, I authorize C&H International to charge my credit
card for the amount described above. Payment in full to be made when billed or in extended payments in
accordance
with standard
policy of credit
card issuing company. I future acknowledge that I have been informed of the cancellation and refunds policies
of C&H International and agree to the terms and
conditions. I waive my right to dispute these charges. |
Cardholder's
Signature: |
____________________________ Date: ________________ |
|
|
|
Travel Agent : Cathy Balbir
Kaur
Agency Name: Apana Special
Worldwide Deals (C&H Houston)
Address: 10700 Richmond Ave,
#202, Houston, Texas 77042
Phone Number:
1 713 614 9028
Fax Number :
1 713 334
2828
Agent
Cathy Booking - Fax form and supporting documents to (713)
334-2829
For
Online Bookings - Fax form and supporting documents |
|
CST # 1016644-40 |