Bike China Adventures, Inc.4448 Aldrich Ave South
Minneapolis, MN 55419 USA
Phone (86) 1388-2266-575 (+8 GMT)
USA Toll-Free 1 (800) 818-1778
USA FAX (888) 661-1851
Credit Card Authorization Fax Form
To pay by credit card, print out this authorization form and fax to our US FAX number: 1 (888) 661-1851.
Here are other fax form formats:
Adobe Acrobat format Authorization Form
MS Word format Authorization Form.
Instructions:
1. Complete this form by printing legibly with a dark pen all billing information in the blanks below.
2. Sign with the credit card holder's signature on the line indicated.
3. Fax this form to our secure fax machine in the US at
1 (515) 322-0300.
I, __________________________________ hereby authorize Bike China Adventures, Inc.
to charge my credit card in the amount of US$___________________.
Type of Card (circle one): Visa MC Amex Discover
Credit Card Number: ____________________________________
Expiration Date: _________________ CVC Code* ____________
*CVC Code is the last three digits of the number on the back of the card
Credit Card Billing Information
Name on Credit Card:_____________________________
Exact Billing Address: _________________________________
_______________________________________________
City: ___________________________________________
State/Province: _________ Zip/Postal Code: __________
Country: _______________________________________
Telephone:______________________________________
Email: __________________________________________
As the credit card holder, I hereby authorize this charge.
Cardholder's Signature ______________________________
Date ______________________________________________
Complete and fax to: USA FAX: 1 (888) 661-1851