TO: ASTRA Fax:  7 499 409 5971 Tel :  7 499 409 5971 E-mail:  visa@visaru.com

FROM: Phone:   Fax:       Company:

CREDIT CARDHOLDERS AUTHORIZATION

I lieu of my credit card imprint I (name of credit card holder shown on credit card),

hereby authorize "Astra Inc." to charge my credit card.

AMEX  VISA  MASTERCARD  DINERS JCB

#    Valid till / MM/YY

In the amount of

CSC (card security code). The last 3 digits AFTER the credit card number in the signature area of the card    

Batch code (4 figures just above the main line of figures)  (for AMEX cards only)   

This charge is related to travel services for myself and/or (full name of each passenger if other than cardholder)
Passenger 1
Passenger 2
Passenger 3
For the following services

My billing address
Phone: Fax:
E-mail:

By signing below, I acknowledge charges described herein. Payment in full to be made when billed or in extended in accordance with standard policy of card issuer. In case of bank canceling authorization, "Astra Inc." has the right to cancel reserved services. Attention! We don't accept Visa Electron.
While paying by credit card you pay 5% more as tax.

Name   Signature of cardholder ___________________

Date:  "_____" ________________ 201__

PLEASE FAX US THIS FORM BACK
TO 7 499 409 5971

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