PERUBOLIVIAARGENTINA

CREDIT CARD CHARGE AUTHORIZATION

I,___________________________________, authorized Loki Travel S.A.C to use the following Credit Card to charge on my behalf and my companion(s).

Credit Card : VISA ( )

Card Number ____________________

Expiration Date ____________________ (mm/yy)

Alpha or Security Number ____________________

(Please check this number on back of your Credit card)

The Total amount of US$ ____________________

Customer Billing Information / Información de facturación del cliente

Cardholder’s billing address ________________________________________

City ________________________________________

Country / State / Zip Code ________________________________________

Phone Number ( ) ________________________________________

Passport or Identity number (Applied to your credit card) _____________________

Cardholder agrees to the Terms and Conditions and acknowledges the services to be provided and/or performed. Any and all disputes shall be resolved directly and internally with View Peru and Signatures EIRL

Cardholder’s signature ___________________________________ Date ____________(As it appears on credit card)

Worldwide: +51 84 244976cusco_tourdesk@lokihostel.comwww.lokihostel.com/en/travel