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Cheque Debit Authorization
Cheque Information
Account Number :* Cheque Date :*
Routing Number :* Cheque Number :*
Bank :* Branch :*
Billing Information
First Name :* MI : Last Name :*
Address 1:*
Address 2:
City :* State :*
Country :* Zip Code :*
Primary Phone :*
Secondary Phone :
Email :*

I here by authorize Ransi Travels or it's affiliate or the transporting airline to debit my bank account mentioned above for the amount of USD $ towards payment of airline tickets as per the details mentioned in reservation form. I recognize that the above amount may be different from the amount that appear on my tickets. I understand that taxes and service charges are included in the above amount and penalties apply for cancellations/changes/refunds.

Signature of the Account Holder   Date :
Note : Please send us cheque and reservation form along with this authorization form.
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