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PAYMENT / GUARANTEE FORM
Please complete the following form and return it by fax or mail to:
Travel
agency VISIT LITHUANIA
Odminiu str 5, 01122, Vilnius, Lithuania
Fax: 00370 5 2625 242
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Surname _________________________________First
Name__________________________
Address_________________________________________ Phone
number________________
E-mail______________________________________________________________________
Ref No ______________________________________________
Date of accommodation _____________________________________________________
Charge
__________________ to
my:
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O
VISA Card O MasterCard
Card Number
______________________________________
Expiry date______________________________
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O
By
signing this form I authorize VISIT LITHUANIA to charge the above credit card
for the balance of my
account for services ordered.
O
This form is to guarantee my reservation. In case of late cancellation or
no-show I authorize VISIT LITHUANIA
to charge the above credit card for
one nights stay.
I certify that I have read and do accept the conditions of reservation and
cancellation rules.
SIGNATURE:
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