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PAYMENT FORM
Please complete the following form and return it by fax or mail to:
Travel
agency VISIT LITHUANIA
L.Stuokos-Guceviciaus 1, 01122, Vilnius, Lithuania
Fax: 370 5 2625 242
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Surname _________________________________First
Name__________________________
Ref No ______________________________________________
Date of accommodation _____________________________________________________
Charge
__________________ to
my:
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VISA Card
£ MasterCard
Card Number
______________________________________
Expiry date______________________________
Security code____________
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By
signing this form I authorize VISIT LITHUANIA to charge the above credit card
for the balance of my account for services ordered.
I certify that I have read and do accept the conditions of reservation and
cancellation rules.
SIGNATURE:
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