Syaza Travel & Tours

No 18/AF & 18M, Jalan Kosas 1/5, Taman Kosas, Ampang, SEL Selangor 68000
Tel: +603-4296 2019
Email: info@syazatravel.com.my

Credit Card Authorization

Please complete this form and return it via email, mail or drop off at our office. With a copy of your Credit Card and any ID (mandatory).

 
*Travel Agent's Name: _____________________________________________________
*Passenger(s) name:   FAMILY NAME FIRST NAME
  1. ________________________ ________________________
  2. ________________________ ________________________
  3. ________________________ ________________________
  4. ________________________ ________________________
  5. ________________________ ________________________

*Itinerary:

Origin: ____________________ Destination: ____________________
Departure Date: ____________________ Return Date: ____________________
Airlines: ____________________    


*Cardholder Name:
(AS shown on the credit card): _________________________________________


*Credit Card type: Visa Master Card American Express