MANILA FORWARDERS - TRAVELPH.COM
CREDIT CARD AUTHORIZATION FORM
ATTENTION : Reservations Officer : __________________________
California U.S. Fax No : +1 818 700-1555 | Manila Philippines Telefax No. +632 7933-9714
In lieu of my credit card imprint, I _______________________________________________, Authorize
Manila Forwarders to charge my credit card (VISA, MasterCard, American Express)________________
_______________________________ (account number) which expires on ______________________
the amount of _________________________ for the payment of shipping cost :
Name of Shipper: ___________________________________________________________________
Address : __________________________________________________________________________
Telephone: _____________ Cel: _______________ email : __________________________________
Name of Consignee: _________________________________________________________________
Address___________________________________________________________________________
Telephone: _____________ Cel: _______________ email : __________________________________
NOTE: Please include CLEAR photocopies of your Goverment Issued ID. Please fax back completed
form to Ca U.S. Fax: +1 818 700-1555 OR Manila Philippines Telefax No. +632 7933-9714. These
requirements are checked by the approving bank. If you have no passport, please provide photocopies
of your Driver's License or Company ID. These are strict requirements for approval
of your payment.
Credit Card Information
Name On Card : ____________________________________________________________________
Credit Card Number : ________________________________________________________________
Issuing Bank : _______________________________________Expiry Date:_____________________
Billing Address : ____________________________________________________________________
Office/Work Address : _________________________________Zip Code: ______________________
Office/Work Tel No. / Fax No. : ________________________________________________________
Home Address : ______________________________________Zip Code:_______________________
Home Tel No. / Fax No: ______________________________________________________________
Type of Card : (Please check) |__| VISA |__| MASTERCARD |__| Amexco
3-Digit ID Code: (Located at the back for VISA or MASTERCARD) :___________________________
4-Digit Batch Code: (Located in front-right part of the card for AMEXCO) : ______________________
Passport Number : ____________________________________Birthdate :____________________
*Passport Number will be used as a proof of your identification as required
by our approving bank.
_________________________________________________________________________________
Cardholder's Signature Date
Manila Forwarder 3964 Eagle Rock Blvd, Los Angeles, CA USA 90065 (USA
Office)
Manila Forwarder Phil, Inc. (Manila Office)
#38-E Con St, Gama Compound, Rincon Rd., Valenzuela City, Metro-Manila, Philippines 1444
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