Payment can be made by (American Express /Visa & MasterCard ) credit card. We need a letter from you authorizing us to collect the money along with clear photocopies of both sides of the credit card and a copy of the relevant pages of your passport. These documents can be sent to us by fax.
Indebo (India) Pvt Ltd.
116-117, Aurobindo Place
Hauz Khas
New Delhi – 110 016, INDIA
(Fax # 00 91 11 47165550)
AUTHORISATION TO DEBIT MY CREDIT CARD
Dear Sir,
In connection with my/our tour arrangements in India, I hereby authorize INDEBO (INDIA) PVT LTD, to Debit my AMERICAN EXPRESS/ VISA/ MASTER CARD, in Equivalent Rupees, as per the details given below:
Name as on the Card (Mr/ Mrs/ Ms) |
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Card No |
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Expiry date |
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The FOUR DIGIT security code of my Card is: (Applicable only for American Express Card) |
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The sum of US Dollars/INR |
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My passport details are: |
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Nationality: |
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Passport No : |
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Date of Issue : |
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Date of Expiry : |
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Place of Issue: |
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Date of Birth: |
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My current Card billing address is: |
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The telephone number where I can be reached in the next 72 hours is: |
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Mobile Telephone Number |
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I enclose a copy of the obverse and reverse of my card, and relevant pages of my passport as identification.
I also confirm that this payment is irrevocable, and is an authority for this transaction only.
I understand that the Record of charges will neither bear my signatures nor the imprint of the Card and I therefore undertake to unconditionally honour and pay without any demur and contentions, the charges as when I am billed for the same.
I understand that any amount drawn from my credit card will first be cleared with the credit card authorization facility and that all credit card payments incur a 3% surcharge.
| Name and Signature of Cardholder
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Date
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Place
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Download Payment Form
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