Credit Card Payment Authorization Form



To: (86)28-87562424                                                                   

Access Tibet Tour

Tashidelek, subsidery No. 1,

No.41 Middle Beijing Road, Lhasa

Tibet, China


From:  ________________________________________ ( Your Full Name)


 Billing Address: ______________________________________________ (Street)


______________________________________________(City, State, Zip, Country)


This is to guarantee my payment to ACCESS TIBET TOUR after ACCESS TIBET TOUR has confirmed my booking for the requested travel service.


To the Bank of China:


I hereby authorize ACCESS TIBET TOUR, to charge the amount of US$___________ from my Credit Card as my payment for my tour to Tibet I reserved from Access Tibet Tour.              


Access Tibet Tour has a copy of my card, the number and expiration date as detailed below:


Credit Card Type: _____________ Card Holder¡¯s Name: _____________________



Credit Card Number: _________________________________________________

(Please write it clearly)


Expiration Date (MM/YYYY): ______/___________


Card Holder¡¯s Birth date (MM/DD/YYYY): ____/____/______Nationality: __________


Issuing Bank of your credit card: ___________________________________


My phone number: ______________________________


My passport number: ______________


Your Signature:

____________________________(Should be the same as on your credit card)



Note: The Bank of China requires a legible photocopy of both sides of your credit card. Please, send the copy (page 2) with this form.



Please fax it to: (86)28-87562424






                                                                                                                                    Page 2 of 2


Please make photocopies of the both sides of your credit card:








Copy of your credit card (front)










Copy of your credit card (back)





Please fax it to: (86)28-87562424




Please, fax this page with your completed Authorization form. (Page 1)