|
Chaykovskogo St. 18, St-Petersburg, Russia. Tel./fax: +7 812 7197656, +7 812 7196428. E-mail: info@naparome.ru Skype: naparome |
|
Oder. Booking form:
| Surname | |||
| Given name | |||
| Date of birth |
| Route | ||
| Date of departure | ||
| Time | ||
| Ship | ||
| Cabin | ||
| Vehicle | ||
| Meals |
Your phone, fax, e-mail : ________________________________________
You can send your Oder to e-mail: info@esline.ru or to fax +7 812 7196428
AUTHORIZATION
Hereby
I authorize Ferry Travel Agency "E. & S." Ltd to charge my
credit card for the service of your company without my additional instructions
Please print
|
Cardholder’s
Name: |
|
|
Company
(if corporate): |
|
|
Issuing
Bank: |
|
|
Card
Number: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Expire
Date: |
|
|
Card
type:
CVV2
(Card Verification Value) / CVC2 (Card Verification Code): |
|
|
Cardholder
ID: |
|
|
Cardholder’s
address, Phone, Fax, E-Mail: |
|
|
Amount
in words: |
|
|
Amount
in figures: |
|
Cardholder’s
signature: _______________________ Date: _________________
You can send your Autorization to fax +7 812 7196428
