SAVITA TRAVELS

INTERNATIONAL & DOMESTIC

190 Suffolk Avenue, Staten Island, NY 10314 Tel : 1-718-552-7528,  Fax :1-718-370-1475

Credit Card Holders Authorization

(Please print this form and send/ fax the filled form to the above address)

 In lieu of my credit card imprint, I _____________________________________________________ (Name as  shown on Credit card)

 herby authorize ____________________________________________________________________(Name of  Agency/issuing Carrier)

 charge these to my _______________________________________________________(Name of the Credit Card)

 Account  # ________________________________________________, Exp Date _________________________

 In the amount of $__________________________________________________

 for the payment of transportation of myself and or_______________________________________________(Full  name of passenger)

 for itinerary as follows ___________________________________________________(Complete Routing)

 Note: Please provide clear copies of credit card (front & back), Driver's license and proof of billing address if  different from driver's license.

 By Signing below, I acknowledge the charges described above. Payment in full to be made when billed or in  extended payment. In accordance with standard policy of company issuing the card, I acknowledge that the  tickets are non-refundable.

 X _________________________________________ (Signature of Card Holder).