E.M.C. Logistics GmbH
WWW. .COM
Flinschstr., 2-4 60388 Frankfurt/Main Tel: +49 (0)69 770 622 700 Fax: +49 (0)69 770 622 760 E-Mail:
Bankverbindung: Commerzbank 60311 Frankfurt/Hauptwache
IBAN: DE17 5004 0000 0570 3483 00 SWIFT/BIC: COBADEFFXXX USt-IdNr.: DE221309326
CREDIT CARD AUTHORIZATION FORM
Date:
I, _, hereby authorize the E.M.C. Logistics GmbH – Alice Travel to charge my Credit Card with the
amount of +3% (AmEx cc fees) Euro for
Credit Card type: □ American Express (+3% cc fees)
Card Number:
Expiry Date:
/
CVV ______(4 digits on front right side of the card)
Name of Cardholder:
Billing Address:
Phone Number :
I will not dispute the payment with my credit card company, so long as
transaction corresponds the terms indicated in this form
Signature of Cardholder:
Please also enclose a copy of the front and back side of your credit card as well as copy of valid State ID with photo and fax the signed Authorization Form to:
+ 49 69 408 997 69.
If you have any further questions, please do not hesitate to contact us as follows: Phone: + 49 69 770 622 700
Fax: + 49 69 770 622 760
E-Mail:
Accounting Department
Eingetragen im Amtsgericht Frankfurt am Main. HRB 54364
Erfüllungsort und Gerichtsstand für beide Teile ist Frankfurt am Main.
Bankverbindung: Commerzbank AG. IBAN: DE17 5004 0000 0570 3483 00 / SWIFT/BIC: COBADEFFXXX
E.M.C. Logistics GmbH
WWW. .COM
Flinschstr., 2-4 60388 Frankfurt/Main Tel: +49 (0)69 401 486 00 Fax: +49 (0)69 408 997 69 E-Mail:
Bankverbindung: Commerzbank 60311 Frankfurt/Hauptwache
IBAN: DE17 5004 0000 0570 3483 00 SWIFT/BIC: COBADEFFXXX USt-IdNr.: DE221309326
CREDIT CARD AUTHORIZATION FORM
Date:
I, _, hereby authorize the E.M.C. Logistics GmbH – Alice Travel to charge my Credit Card with the
amount of +3% (Visa or Euro/MasterCard cc fees) Euro for
Credit Card type: □ Visa (+3% cc fees) □ Euro/MasterCard (+3% cc fees)
Card Number: ------
Expiry Date:
/
CCV ______(3 last digits on back side of the card)
Name of Cardholder:
Billing Address:
Phone Number :
I will not dispute the payment with my credit card company, so long as
transaction corresponds the terms indicated in this form
Signature of Cardholder:
Please also enclose a copy of the front and back side of your credit card as well as copy of valid State ID with photo and fax the signed Authorization Form to:
+ 49 69 408 997 69.
If you have any further questions, please do not hesitate to contact us as follows: Phone: + 49 69 401 437 74
Fax: + 49 69 408 997 69
E-Mail:
Accounting Department
Eingetragen im Amtsgericht Frankfurt am Main. HRB 54364
Erfüllungsort und Gerichtsstand für beide Teile ist Frankfurt am Main.
Bankverbindung: Commerzbank AG. IBAN: DE17 5004 0000 0570 3483 00 / SWIFT/BIC: COBADEFFXXX