Credit Card Authorisation form

The Cuban Travel Network. (Funky Tours Adventures. 9080-3982 Québec Inc) 5470 Chabot, Montréal, Québec, Canada. H2H 1Z2.

Tel: 514.227.2257 Fax: 514.227.2258

CREDIT CARD AUTHORIZATION FORM

Please print, complete and fax to the following fax number: 514.227.2258

Name:

Telephone number

Name of Establishment/Property:

Name on Card:

Card Type: (Visa or Mastercard only)

Card No:

Expiry Date:

3 Digit card ID (CVV - last 3 digits on back of card) - ESSENTIAL for transaction to be run: Please see diagram:

Amount authorized:

Date of this authorization:

__________________________________________
SIGNATURE

Your card will be charged in Canadian dollars under the name Funky Tours travel, Montreal, Canada. Depending on the daily exchange rate, the amount charged to your card may vary by a small degree. . Please send us an e-mail at: confirmation@travelcuba.net if you have been overcharged.

Name:
Telephone number
Name of Establishment/Property:
Name on Card:
Card Type: (Visa or Mastercard only)
Card No:
Expiry Date:
3 Digit card ID (CVV - last 3 digits on back of card) - ESSENTIAL for transaction to be run: Please see diagram:
Amount authorized:
Date of this authorization:

__________________________________________ SIGNATURE
Your card will be charged in Canadian dollars under the name Funky Tours travel, Montreal, Canada. Depending on the daily exchange rate, the amount charged to your card may vary by a small degree. . Please send us an e-mail at: confirmation@travelcuba.net if you have been overcharged.