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CREDIT CARD AUTHORIZATION FORM
 

Instructions

  1. Include a photocopy of the front side of your credit card.
  2. Include a photocopy of your passport.
  3. Fax or email all this along with this form to our this along with the scanned copies to enquiry@gogoa.com

                 I hereby authorize GoGoa to debit my credit card as per details given below.
Card Holders Name ..........................................................................................
Type of Card (Visa/Master) .........................................................................................
Credit Card No.   ........................................................................................
Expiry Date ........................................................................................
Amount in Indian Rupees ........................................................................................
Billing Address of Card Holder ........................................................................................
  ........................................................................................
  .......................................................................................
Card Holders Contact No. ........................................................................................
Card Holder’s Signature .......................................................................................
Date .......................................................................................


All Information entered on this form will be kept strictly confidential by Go Goa

 

 

Ground Floor, Mahaveer Apartments, Plot No.584 / 585, 3rd Road, Khar(W), Mumbai-400052, India.
Tel : +91 22 6500 1122   Fax : +91 22 2648 3910   Email : enquiry@gogoa.com