<p> Tel: 1-800-956-8873 5990 158th Ave SE, Bellevue WA 98006 Fax: 425-484-2133 www.lotustours.net Email: [email protected] </p><p>Send this form to Lotus Travel agent either thru fax 425-484-2133 or email to [email protected].</p><p>CREDIT CARD AUTHORIZATION FORM (FOR VISA PROCESSING)</p><p>I, ______, authorize Lotus Travel, Inc., a tour operator acting on my behalf, or through a travel agent, to apply charges to the following credit card, for travel and travel related services for me (the undersigned), and/or the following named persons mentioned below. If any charge back or dispute arises from my authorized charge, I will be fully responsible for the payment and will hold Lotus Travel, Inc. harmless for any amount that is charges back or disputed. All charge backs or disputed amounts must be paid back to Lotus Travel, Inc. promptly. This letter will also waive and indemnify Lotus Travel Inc. from any harm or occurrence from a charge back. Persons traveling, or for whom I am responsible for payment on my credit card:</p><p>NAME (LAST NAME, FIRST & MIDDLE NAME) NATIONALITY DATE OF VISA TYPE (Please advise if the ENTRY (Single / traveler is China born) (DD/MMM/YY) Double / Multiple) 1. 2. 3. 4. 5. Card type: □ MasterCard □ Visa □ Discover</p><p>Card #:______Exp. Date: ______Security Code: ______</p><p>PRINT card holder’s name (as it appears on card):______</p><p>Billing address of card holder:______</p><p>City:______State:______Zip code:______</p><p>Delivery address (if different from above):______</p><p>City:______State:______Zip code:______</p><p>Home telephone:______Work telephone:______</p><p>Email address(es):______</p><p>Please note—final documents CANNOT be released until Lotus Travel, Inc. receives all signed credit card authorizations. Refusal to complete or submit authorization form will automatically forfeit all reservations. Please discuss any question or concern regarding invoice directly with your travel advisor prior to submitting document. Tel: 1-800-956-8873 5990 158th Ave SE, Bellevue WA 98006 Fax: 425-484-2133 www.lotustours.net Email: [email protected] </p><p>X______$______USD</p><p>Signature of card holder (as it appears on card) Authorized amount</p><p>Please MAIL the visa application form, passport and required documents to: MR. ROBERT LO, 230 North Garfield Ave., Suite 11, Monterey Park, CA 91754 / Tel. No: (626) 572-0524</p><p>Please note—final documents CANNOT be released until Lotus Travel, Inc. receives all signed credit card authorizations. Refusal to complete or submit authorization form will automatically forfeit all reservations. Please discuss any question or concern regarding invoice directly with your travel advisor prior to submitting document.</p>