Diversion Dive Travel - Bookings | Fax Back Credit Card Authorisation

Fax - Credit Card Authorisation Form
Please complete this form, print it out, sign it
and fax it back to Diversion Dive Travel
on 07 4039 0300 (Intl: +61 7 4039 0300)

Full Name:

Address:

City:

Country:

Postal Code:

Phone: Fax:

Email:

Card Type:

Cardholder Name:

Card Number:

Expiry Date: Month: Year:

Sequence Number: (Usually on back of card)

Issuing Bank:

Please enter details of the services you wish to purchase/book, or just copy
and paste the relevant details from the email that you received from us.
.

We strongly recommend comprehensive travel insurance cover.

Insurance choice:

By sending this credit card authorisation, I confirm that I know and acknowledge the booking terms and conditions and authorise DIVERSION DIVE TRAVEL
to use the above credit card to pay for travel services purchased by me.
Signature: ............................................................................
Date: / /

Full Name:
Address:
City:
Country:
Postal Code:
Phone:		Fax:
Email:
Card Type:
Cardholder Name:
Card Number:
Expiry Date:	Month: Year:
Sequence Number:	(Usually on back of card)
Issuing Bank:
Please enter details of the services you wish to purchase/book, or just copy and paste the relevant details from the email that you received from us. .
We strongly recommend comprehensive travel insurance cover. Insurance choice:
By sending this credit card authorisation, I confirm that I know and acknowledge the booking terms and conditions and authorise DIVERSION DIVE TRAVEL to use the above credit card to pay for travel services purchased by me. Signature: ............................................................................ Date: / /