AUTHORIZATION LETTER
(Attachment copies of 2 sides of the card)
 
  *Full name. Nationality
  *Passport number Date of Issue :
    Date of Expiry :
  *Your Address.
  *Phone Number. Fax Number.
  *Email Address.
  Accompany with
Hereby authorize the following company
  Company Name :  Rose Travel Service Co., Ltd.      
  Address : 111 Ba Trieu St. , Hoi An Town, Quang Nam Province- Vietnam
  Tel : + (84 510) 3 917 567 Fax:  + (84 510) 3 916360
  Email :      
 
  To withdraw the amount of $US (including 3% service charge)
  Total in words
    from my personal bank account by using my Credit card.
  *Type Card: Visa | Master
  *Credit Card No
  *Cardholder Name
  *Credit Card Bank
  *Expiry date | *Card ID (Example)
This amount is the payment for the following services.

No.

Description

Amount

Total:

3% Service Charge

Grand total:

Client’s signature sample.

Signature of the card holder

Signature of the card holder

Signature of the card holder