CREDIT CARD AUTHORIZATION FORM reserv@clovertours.com      www.clovertours.com

I hereby authorize Clover Tours and/or its agency representative/wholesaler to issue any travel documents and charge one of my credit cards upon my verbal and/or written request.

American Express     Master Card     Visa     Dinners     Others

Credit Card Number Sec. Code Exp.

For the purchase of services in the name of the following persons:

1.   AMOUNT USD 2.   AMOUNT USD 3.   AMOUNT USD 4.   AMOUNT USD 5.   AMOUNT USD 6.   AMOUNT USD

TOTAL AMOUNT USD

Name as appears on credit card

Billing Address:                                                                              Remarks: Street:   City : State : ZipCode : Country:

SIGNATURE ________________________________________________________

E-ticket whenever available Regular mail in USA (free, allow 5 bussiness days) Next Day Delivery by Fedex in USA USD 18.00 Fedex USA to Brazil USD 45.00

PS: Please send a copy of front and back of the credit card and identification.

11077 Biscayne Blvd. · Suite 210 · Miami, FL 33161 · USA · Phone: 305-891-6161 · Fax: 305-891-6262

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