Probashi Travel Hajj

5 Frederick Pl.
Parlin, NJ 08859
Tel: (732) 451-3969
Email: info@probashitravel.com

Credit Card Authorization

Please complete this form and return it via email, mail or drop off at our office. With a copy of your Credit Card and any ID (mandatory).

 
*Travel Agent's Name: _____________________________________________________
*Passenger(s) name:   FAMILY NAME FIRST NAME
  1. ________________________ ________________________
  2. ________________________ ________________________
  3. ________________________ ________________________
  4. ________________________ ________________________
  5. ________________________ ________________________

*Itinerary:

Origin: ____________________ Destination: ____________________
Departure Date: ____________________ Return Date: ____________________
Airlines: ____________________    

*Charge Amount:         $____________________

 

*Cardholder Name: (AS shown on the credit card): _________________________________________

*Credit Card type: Visa Master Card American Express