📄 Extracted Text (123 words)
FOR OFFICE USE ONLY
Date receited
ot VIP
ti alotTED OUTPOSTS Travel spedakt
SAFARI & TRAVEL CO. ? FS
CREDIT CARD AUTHORIZATION FORM
NAME ON CARD
(Please Print)
Type of Card: O Visa El MasterCard O American Express O Discover
Credit Card Number:
Amount: Security Code: Expires:
(On Back of Card) (Month/Year)
O Please check this box If we may use this credit card for purchase of travel Insurance.
Mailing Address: (as appears on your billing statement)
Street
City State Zip
I do hereby authorize Uncharted Outposts to charge my credit card in the amount of US Dollars
for my travel arrangements and take full responsibility for the above charges.
Cardholder's Signature Date
Uncharted Outposts I p: 505.795.7710 505.795.7714 I www.unchartedoutposts.com
EFTA_R1_01520600
EFTA02444234
ℹ️ Document Details
SHA-256
7fb358d5cfd00030e9865d7056bb742be87c8006d6d36747b69cabdcd021bdc9
Bates Number
EFTA02444234
Dataset
DataSet-11
Document Type
document
Pages
1
Comments 0