ATTENTION :Lakbay.Net Reservations

 FAX :(632) 636-0654
Transaction Code : __________________

  

This is to authorize Kalakbayan Travel Systems, Inc. to debit the total amount of


______________________________________________________________

(amount in words)
PhP _________________________________________________


Only against my credit card as payment for my reservation described below :



My Credit Card details are as follows :
Name Printed on Card _________________________________________
Credit Card Number _________________________________________
Last 3 digits at the back of card
(for VISA / Mastercard) or		 _________________________________________
   
4 digit Code located right below the Credit Card
(for VISA / Mastercard)		 _________________________________________
Last 4 digits at the back of card
(for AmexCo)
>>note : located either on the upper left, upper right, lower left or lower right of the credit card (back portion)		 _________________________________________
Expiry Date _________________________________________
Name of Issuing Bank _________________________________________


Type of Card1 VISA MasterCard JCB AMEX

Billing Address _____________________________________
  _____________________________________
E-Mail Address _____________________________________
Telephone Number _____________________________________
Date of Birth _____________________________________


____________________________   ____________________________
Signature of Cardholder
 
Date
Note :
  1. Kindly Fax us a copy of the FRONT and BACK portion of your Credit Card
  2. Processing fees may apply in certain cases.
  3. All payments shall be made IN FULL.
  4. Only send Lakbay.Net Credit Card Form after you have received an official Booking Confirmation from LakbayRESERVATIONS. For immediate assistance call (632) 635-4212 or 631-1892.