TO-MA TOUR TRAVEL AGENCY

H-1051 Budapest

Nádor utca 20.

Tel: +36-1-3530819 Fax: +36-1-7990848

Please print this form, and return it to us by fax including the copy of both sides of your credit card!

 
   print

 

Hereby I (name of cardholder):

 
 

date and place of birth:

 
 

passport or id card number:

 
 

address of cardholder:

 
 

telephone:

 
 

name of the passanger:

 
 

booking reference:

 

authorize TO-MA TOUR Ltd. to charge my credit card

 

type of credit card:

 
 

credit card number

 
 

CVC-code:

(last three digit security number on back of card, in the signature panel)

 
 

expire date:

 
 

with amount of EUR:

 

____________________________________          _____________________________________

                                             signature of cardholder                                                                       date

 


                            Please fax us the copy of both sides of the credit card!