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CREDIT CARD AUTHORISATION Please complete this form to authorise SkiJapan.com to debit your credit card. Please use your Surname or SkiJapan.com Trip number as payment reference for your deposits. ď Ż Credit Card:

Online payment option is available at www.skijapan.com. Visit the Travel shop and select Trip Payment.

or fill in the details below and your SkiJapan.com Consultant will process the payment for you.

Amount Paid:

$

Credit Card Type (please circle one):

MasterCard

Visa (1% fee applied to Visa/Mastercard payments)

Amex (3.1% fee applied to all Amex payments)

Credit Card Number:

Expiry Date:

CVC Security Code:

Please print name that appears on the card:

Date:

Signature:

By signing the above, I understand and agree to the responsibilities, Terms and SkiJapan.com booking conditions listed at the back of all SkiJapan.com brochures and I acknowledge that it was highly recommended that I purchase travel insurance to protect against unforeseen circumstances. I agree that all names are correct as per passport(s) and understand that a fee of up to $150 will be charged to change an airline ticket after issue. Complete name changes are not permitted.

PLEASE FAX COMPLETED FORM TO SKIJAPAN.COM on (02) 9938 9999 Trip No:

Your SkiJapan.com Consultant:

SKIJAPAN.COM UNIT 213/ 20 DALE ST, BROOKVALE, SYDNEY, N.S.W, 2100. PO BOX 7163, WARRINGAH MALL, BROOKVALE NSW 2100 TEL: +61 2 9938 9900 ; FAX: +61 2 9938 9999 EMAIL: enquiries@skijapan.com

979  

http://skijapan.com/attachments/db/sjp/979.pdf