RIYA TRAVEL INC CREDIT CARD AUTHORIZATION FORM

In lieu of my credit card imprint, I hereby authorize, Riya Travel & Tours, Inc. to charge my VI / MC / DS / AX / DC (credit / debit card) in the amount as mentioned below for payment of transportation for myself and/or other passengers. Details are as given below:

Billing Details

Riya Booking Reference No. (PNR) *

Name of Sales Person: *

Customer Name: *

Card Holder Name as on card: *

Credit / Debit Card Number: *

Credit / Debit Card Expiry Date: *

/ 20

Amount to be paid *

Name of passenger other than card holder:

Address1*

Address2

City*

State*

Country*

Zip Code*

Contact Details

Work Phone:

Home Phone:

Cell Phone

Email Id: *

Driving Licence Number: *

Upload Document:

I / We confirm that I / We have read the Terms and Conditions online and accepted all the Terms and Conditions governing our purchase of air ticket or any other services from Riya Travel & Tours Inc. In addition I / We also confirm that I / We have verified that all information entered during the reservation process is accurate. I / We also acknowledge that this will serve as your electronic signature. (Please check the box to continue)

Contact Us: +1 877 669 7492

Card Authorization

RIYA TRAVEL INC CREDIT CARD AUTHORIZATION FORM

Billing Details

Contact Details