FORUM TRAVEL INTERNATIONAL
& its divisions: Hidden Lodges & FIEU
91 Gregory Lane #21
Pleasant Hill, CA 94523
PHONE/FAX: 925-946-1500 or 925-997-1864
Email: fti@foruminternational.com, lodges@hidden-lodges.com, info@fieu.edu

CREDIT CARD AUTHORIZATION FORM

PAYMENT INFORMATION:

Please circle:     AMEX     VISA     MasterCard     Discover

Credit Card Number: _________________________________________

Expiration Date:____________________

SIC Number:___________________ (3 digits on back of Visa/MC/Discover; 4 digits on front of AMEX)

Name on Card: _______________________________________

Credit Card Billing Address: ___________________________________________________

    _________________________________________________________________________

    ________________________________________________________________________




I Authorize Forum Travel International to charge my credit card the total amount of

    $____________________

For travel arrangements to: ______________________________________________

Signature of Credit Card Holder: _________________________________________

Date: ______________________________________________________________




PLEASE FAX BACK TO 925-946-1500