The document is a credit card payment form for a tour company. It requests the cardholder's name, credit card number and expiration date, billing address, telephone numbers, amount to be charged, name of the tour being paid for, and the cardholder's signature authorizing the company to charge their credit card for the listed amount and tour.

1. MASTER / VISA CREDIT CARD PAYMENT FORM
ALL DETAILS SHALL BE FILLED IN CAPITAL
CARD DETAILS
CARD HOLDER’S NAME
CARD NO.
Master/Visa
DATE OF EXPIRY
BILLING ADDRESS
TELEPHONE
City
State
Country
Pin/Zip
Home
Work
Cell
AMOUNT
PAYING FOR(Tour Name)
DECLARATION
In lieu of my credit card imprint, I______________________________, hereby
authorize Compass Indiato charge my credit card as per the details above.
By signing below, I acknowledge the charges described above. I
understand that the above amount is paid for services rendered / to be
rendered to me / my family / travel partners (as may be the case) subject
to the conditions of the SCOPE OF WORK & GENERAL INFORMATION which I
have read and understood.
Signature: _________________ Date (mm/dd/yy): _______________