LIRITA TOURS TOURISM & TRAVEL AGENCY
CREDIT CARD PAYMENT AUTHORIZATION FORM

                       I,  authorize Lirita Tours Tourism & Travel Agency , Urgup - TURKEY.
                               to charge the sum of :

(please indicate currency)

                     TO: Visa Card
 Visa		  Master Card
 Master Card		    
Card Number :
Expiry Date :
Please advise the last three-digit number appearing on signature panel:    Security Number - CVC

My name as appear on the card is :

The above mentioned charge is for :

Card Holder’s Signature and Date:   _________________________
Cardholder's Passport Number:
Cardholder's Address :
Cardholder's Tel. No : Country Code   No
Cardholder's Fax No : Country Code   No

KINDLY FILL OUT THIS FORM ALONG WITH YOUR SIGNATURE, PRINT OUT AND FAX BACK TO
LIRITA TRAVEL RESERVATION DEPT. FAX: +90.384 341 70 78.