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SPOff-line credit card payment
Visa, Eurocard/Mastercard
By printing, filling in and faxing us this form, we are given authorization to charge the complete amount according to the chosen terms of payment. The amount stated in € will be charged to your credit card according to the selling rate of E-banka on the charge date.
Agreement with the charge to your credit card:
| OWNER OF THE CREDIT CARD name: ................................................ surname: ........................................... code of the order: ............................. |
BENEFICIARY ADRIA DATABANKA s.r.o. Panská 2 602 00 Brno FAX: +420 542 215 207 |
PAYMENT OF ACCOMMODATION SERVICES IN APP .......................... IN ...........................
THE COMPLETE AMOUNT: ................................................ Euro
TYPE OF CREDIT CARD:
VISA
Eurocard/MasterCard
NUMBER OF CREDIT CARD: ................................................................................................
validity of the credit card until: ................................................
check code: ................................................
check code: the three numbers that are printed next to the signature slip on the back side of your credit card and that follow the number of your credit card, or they may follow the last four numbers of your credit card number.
number of another personal document for more specific identification:
Driving licence num.: .......................................................
Passport num.: ................................................................
Social security num.: ........................................................
I agree that you charge the amount of ..................................... Euro to my credit card.
DATE:
SIGNATURE:
