To authorise travel payments please: Complete this form, print, then scan/email or fax to Australia Expat Travel. Thank you.

Fax: +61 3 5221 0698

[* required fields]

I, the undersigned, authorise Australia Expat Travel and/or relevant third party provider (as per our quotation) to charge payment of
* AUD$	to my credit card
* Quote Number
* Booking Name
* Email
* Mobile Phone	Quote a number that can be reached whilst on your holiday
* Card Type
* Card Number
* Expiry Date	Expiry date needs to be valid for at least one month after your return from holiday
* Verification Code	[Show me where to find verification code]
* Name on card
* Residential Address in Asia
Detail	Please process final payment automatically from above Please contact me for final payment prior to due date Names on itinerary are correct as per passenger passports
* Billing Address
Cardholders Signature ___________________________________________________