Case File
efta-02444234DOJ Data Set 11OtherEFTA02444234
Date
Unknown
Source
DOJ Data Set 11
Reference
efta-02444234
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
NAME ON CARD
tialotTED OUTPOSTS
SAFARI & TRAVEL CO.
? FS
CREDIT CARD AUTHORIZATION FORM
FOR OFFICE USE ONLY
Date receited
ot VIP
Travel spedakt
(Please Print)
Type of Card:
O
Visa
El MasterCard
O
American Express
O
Discover
Credit Card Number:
Amount:
Security Code:
Expires:
(On Back of Card)
(Month/Year)
O Please check this box If we may use this credit card for purchase of travel Insurance.
Mailing Address: (as appears on your billing statement)
Street
City
State
Zip
I do hereby authorize Uncharted Outposts to charge my credit card in the amount of US Dollars
for my travel arrangements and take full responsibility for the above charges.
Cardholder's Signature
Date
Uncharted Outposts I p: 505.795.7710
505.795.7714 I www.unchartedoutposts.com
EFTA_R1_01520600
EFTA02444234
Technical Artifacts (4)
View in Artifacts BrowserEmail addresses, URLs, phone numbers, and other technical indicators extracted from this document.
Domain
www.unchartedoutposts.comPhone
2444234Phone
505.795.7710Phone
505.795.7714Forum Discussions
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