This form must be printed, completed and faxed to Ekstra Tourism each time a credit card payment is to be made. For your convenience, this page can be printed from our website.

Company name (if any):	_______________________________
Address of card holder:	_______________________________
	_______________________________
	_______________________________

Please include country & regional codes:

___________________	___________________	___________________
home phone number	work phone number	fax number

E-mail address: _______________________________________________

I authorize Ekstra Tourism & Travel, A.Þ. to withdraw the amount appearing below.

Authorization signatureas it appears on the card:	___________________	Date:__/__/__
		month / day / year

Please print name and
surname as it appears on the card: _____________________________________

Credit card type (please circle one):

Visa

MasterCard

Card number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Card security number / PIN: ________ Card expiration date: __ __ __ __ __ __

Total Amount in US dollars: ________________

NOTE: Notification of the credit card transaction will be made within one business day either by email or fax. After the tour(s), Ekstra Tourism will mail an invoice of all payments addressed to the company name. If there is no company name, then the invoice will be addressed to person who authorized the payment.

Please fax this form to Ekstra Tourism: (90) 216-565 6728