Century Travel

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_____________________________ Expiry Date: __________________________________

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Name printed on card:

Batch Code for AMEX:

Credit Card Number:

Last 3 digits at the back of the card:

Billing Address:

Telephone no. (please specify country and area code):

Birthdate:

E-mail Address/es: (1)

1. Above rate cannot be availed with direct reservation to the airlines, hotel, car company but only through reservation via Century Travel Agency either through online reservation/phone reservation or walk-in reservation at our office.
2. For above booking to be activated, customer is required to email centurytravel@centurytravelagency.com notifying that this CENTURY TRAVEL CREDIT CARD PAYMENT FORM has been completely filled-out and faxed to (670) 235-3711.
3. In the event that customer failed to inform Century Travel of the successful transmission of this form via fax to our office, Century Travel will NOT be held liable for the probable non-booking of the reservation request.
4. Upon receipt of CENTURY TRAVEL CREDIT CARD PAYMENT FORM, Century Travel will proceed to the debiting process. Once successful and should all things be in order, reservations will be blocked under your name and final confirmation via e-mail will be sent to you bearing all the details of your reservation.

Attention: _________________________________________________ FAX NO: (670) 235-3711

This is to authorize CENTURY TRAVEL AGENCY to debit the total amount of _______________________________________________________________ ($ ________________ ) against my credit card as payment for my reservation request.