Parent Care | Property Care | NRI Services | Service Apartments Pune | India

Credit Card Authorization Form

Please fill in the form below, take a print-out and fax it to us at +91 20 24476968. or send us scanned copy on info@guardian-pune.com. We apologies for any inconvenience this may cause you, however we assure you that this is in your best interests. It will help ensure your security. If you unable to print this form right now, please contact us.

To,
" Guardian NRI Parental & Property Care Pvt. Ltd".
125 Shukarwar Peth,
Behind Mandai Ganapati,
Pune 411002, (India)

Fax : +91 20 24476968
Tel : +91 20 24484200

Please fill in the form below

Kind Attention
I, The undersigned
Mr. / Mrs. / Ms. / Dr.
hereby authorise Guardian NRI Parental & Property Care Pvt. Ltd. to Debit my
Credit / Debit Card number
Name as on Card :
Expiring on :	/ / (dd/mm/yy)
For the amount of :	( INR / USD )
Amount in words :
Towards : (reason)
I hold a :	Master Card Visa

My passport details
Passport No. :
Place of issue :
Date of issue :	/ / (dd/mm/yy)
Date of Expiry :	/ / (dd/mm/yy)
Date of Birth :	/ / (dd/mm/yy)
Cardholder's Signature