EFTA00521102.pdf

RUSSIAN NATIONAL GROUP 224 West 30 Street, Suite 701, New York, NY 10001 Tel. a, Fax E — Mail: visas@ rnto.org Web: http://www.Russia — travel.com TO: Anastasia Novikova/ Visa Department FROM: CREDIT CARD HOLDER AUTHORIZATION In lieu of my credit card imprint, I, Hereby authorize Russian National Group To charge my: 0 Visa ❑ MasterCard 0 Discover X AMEX Credit card number: Expiration Date: 01/14 The amount of $800 x 2 + 4% = $1,664 as a payment for 2 multiple-entry 1-year business visas to Russia. My billing address/ Mailing address (if not the same as billing) 301 E. 66th St. Apt. 14G New York, NY 10965 Phone number (home / office): By signing below, I acknowledge charges described hereon. Payment in full to be made when billed or in extended payments, In accordance with standard policy of the company issuing the card. Signature of card holder CANCELLATION POLICY: transfers. private sightseeing tours & hotels should be cancelled not less than 3 business days prior to the actual date of arrival (check-in) through Russian National Group office in New York or KMP Group in Russia during their regular working hours (Mon — 10AM-6PM): train & theater tickets or tickets for any other performances arc not refundable. 10% of the total amount is not refundable when pay omit is made by credit card. Visa fees arc nonrefundable. EFTA00521102