Company/Person Name NID/Driving License No. Expire Date Credit Card Company Mastercard VISA Discover AMEX Other Cardholder Name (as written on the card) Card No. Expire Date Charge Amount ($) Street Address City State/Province ZIP / Postal Code Phone Email Address Air Lines Name Passengers Name Terms & Conditions Recurring Charge: This allows vendors to accept multiple scheduled payments from your credit card. A receipt for each payment will be provided and you will also find the charge noted on your credit card and/or bank statement. You also agree that no prior notification will be provided of these charges unless the date or amount changes, in which case you will be notified at least 10 days before payment is collected. One-Time Charge: This option allows a single one-time charge to be made to your card for the amount indicated below and on the date specified. A receipt will be provided and you will also find the charge noted on your credit card and/or bank statement. You also agree that no prior notification will be provided of this charge unless the date or amount changes, in which case you will be notified at least 10 days before payment is collected. I acknowledge that this authorization will remain in effect until it is canceled in writing. I also agree to notify the vendor in writing of any changes in my account information and termination of this authorization at least 15 days before the next scheduled billing date. If the payment date above falls on a weekend or holiday, I understand that the charge may be made on the following business day I also certify that I am the owner of the credit card described above and will not dispute the scheduled payments with my bank/credit card company; provided that the transactions correctly correspond with the terms written on this authorization form. I, hereby agree to the payment of $ to be charged to the credit card specified above on a recurring basis each week/month (day). I acknowledge that my information will be kept on file for future transactions. Upload Your Signature Submit