Australia Expat Travel

A travel agency run by Australian expats, for expats in Asia

To authorise travel payments please, Print page, complete this form and fax to Australia Expat Travel.

Fax: +61 3 5221 0698

Date:3/14/2010 12:22:48 AM

I, the undersigned, authorise Australia Expat Travel to charge payment of

AUD$	to my credit card.
Quote Number:
Booking Name:
E-Mail Address:
Phone:
Card Type:
Card Number:
Expiry Date:
Verification Code:	[Show me where to find verification code]
Name on card:
Residential Address in Asia:
	Please process final payment automatically from above card number on due date
	Please contact me for final payment prior to due date
	Names on itinerary are correct as per passenger passports
Billing Address

Cardholders Signature	___________________________________________________