This form must be FULLY completed and fax to (972) 238 0400 before tickets can be issued.

Dear Sir/Madam,

This is to confirm that, in keeping with all applicable laws, we are instructing DISCOVER TRAVEL, to issue tickets against the credit card listed bellow.It is expressly understood that this amount charged does not include or constitute any additional fee related to our acceptance of credit cards as a form of payment unless permitted by law.

We further represent the credit card holder stated bellow has authorized this transaction and that we will indemnity and hold DISCOVER TRAVEL, harmless with respect to these instructions.

Passengers:

1.___________________________ 2.___________________________

3.___________________________ 4.___________________________

Booking Locator: ____________________________

Card Holder Name: __________________________ Home Phone: ____________

Credit Card Type: Visa / MasterCard / AmericanExpress / Discover / Diners.(No corporate Cards)

Credit Card No : __________________________ Exp. Date: ____/____ ( mm/yy)

Charge amount Passenger: 1._________ 2._________3._________4._________

Total to be charged : _____________ In words(___________________________)

Billing Address:___________________________________________________

State : _______________ Zip/Postal code : _________ Country : ____________

Issuing Bank : ______________________________

Customer service phone no: _________________ (Displayed on backside of your card.)

Card holder signature: _________________________________