Debit Authorization

Debit Authorization by Credit Card Visa or Mastercard
To: Grecia Turismo – Terra dos Deuses Att: Artemis or Michel Nicolaidis
28 Saki Karageorga – Glyfada – 16674 – Athens – Greece
Telephone: 0030 2110127705

This is my irrevocable and without any reservation authority to you to charge my credit card. Sending this authorization I confirm that I agree with terms & conditions of the agency.

Country ____________________ Date _____ / ____ /______
Full Name ____________________________________________
Passport Number _________________ / City _______________
Address _________________________________________________________
Credit Card Number ______ /_______ / _______ / ______
Expiry Date ____ / ____ Amount ________________
CVV (3 digits on the back of credit card) __________
Signature _______________________________________________________
For the following purchased services
_____________________________________________________________________
Send a copy (xerox) of your credit card (both sides)
Print, Sign and Send BY FAX OR SCANNED DOCUMENT!!!!!

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