DS9 Document EFTA01179639

a '---- --- MAGNA aviation aircraft management r charter CREDIT CARD PAYMENT AUTHORIZATION FORM Please complete this form and return by fax to +30 210 9602565 Date: L VS \WA 2 — RE: PAYMENT OF PRIVATE FLIGHT (FFIT3M7). ‘ I the undersigned, NAME/SURNAME ADDRESS: PASSPORT No: DATE OF BIRTH: TEL. Nr.: won to authorize MAGNA TRAVEL LTD. to charge my credit card as follows: (TO > CREDIT CARD N _ EXPIRING DATE: Me credit cad sectary manlier In 3 ord dIglt cede. Security Numbe Fa Vas N50141astoratcL ft b the Last 3 *Su found an the mine demand. Billing Address(*): TOTAL AMOUNT: C.c. R:N. )..)--16‘...) REASON: Full payment of private flight (')If different than above The issuer of the assigned. on this, Member Is authorized to pay the amount shown as TOTAL upon proper press entation. I promise to pay such TOTAL (together with any other charges due there on) subject to and in accord- ance with the agreement governing the use of such card. SALE CONFIRMED AND DRAFT ACCEPTED NO REFUND / CANCELLATION CARDHOLDER'S SIGNATURE: MAGNA TAAVEL ETAICIAllADOXICE TOYFIETIKONYI1HPEEtrii -100M111 39, rAYOMA 16561, AOHNA MAGNA 'HAVEL Ulf. • 0.0.9.1AYOATLAI - AVIA. 999672402 VAT NO EL 9995/2402 EFTA01179639