Credit Card Authorisation

 

 

Client Name: ________________________________________

 

 

Arrival Date in New Zealand: __________________________

 

 

Charges(please circle): Deposit / Final Payment

 

 

Amount to be charged: NZ$________________________

 

 

Type of credit card (please circle): Mastercard / Visa

 

 

Credit Card Number: __________________________________________________

 

 

Expiry: _____________

 

 

Card holder name: ____________________________________________________

 

I hereby authorize Mosaic Travel Limited to charge the above credit card for the charges specified.

 

I have read and understood Mosaic Travel's Terms & Conditions:

 

 

Cardholders Signature: _______________________________________________

 

 

Date: ___________________