' a ---- - MAGNA aviation aircraft management r charter CREDIT CARD PAYMENT AUTHORIZATION FORM Please complete this form and return by fax to +30 210 9602565 Date: L VS \WA 2 — RE: PAYMENT OF PRIVATE FLIGHT (FFIT3M7). ‘ I the undersigned, NAME/SURNAME ADDRESS: PASSPORT No: DATE OF BIRTH: TEL. Nr.: won to authorize MAGNA TRAVEL LTD. to charge my credit card as follows: (TO > CREDIT CARD N _ EXPIRING DATE: Me credit cad sectary manlier In 3 ord dIglt cede. Security Numbe Fa Vas N50141astoratcL ftb the Last 3 *Su found an the mine demand. Billing Address(*): TOTAL AMOUNT: C.c. R:N. )..)--16‘...) REASON: Full payment of private flight (')If different than above The issuer of the assigned. on this, Member Is authorized to pay the amount shown as TOTAL upon proper press entation. I promise to pay such TOTAL (together with any other charges due there on) subject to and in accordance with the agreement governing the use of such card. SALE CONFIRMED AND DRAFT ACCEPTED NO REFUND / CANCELLATION CARDHOLDER'S SIGNATURE: MAGNA TAAVEL ETAICIAllADOXICE TOYFIETIKONYI1HPEEtrii -100M111 39, rAYOMA 16561, AOHNA MAGNA 'HAVEL Ulf. • 0.0.9.1AYOATLAI - AVIA. 999672402 VAT NO EL 9995/2402 EFTA01179639