If you want to use somebody else’s credit card to pay us, please print this page, have the cardholder fill it out and fax it to us with the following documents to ++41 21 331 48 40:

1. A photocopy of both sides of the credit card
2. A photocopy of a recent credit card statement
3. A photocopy of the cardholder passport or driver’s license
4. A photocopy of your passport or driver’s license

I authorize Micheloud & Cie to bill my credit card for the amount [………………...] for a service offered to […………………………………………………………………..]. I declare that I have read and approved Micheloud & Cie's business conditions including its refund policy.

Cardholder's Name:

Credit card type:

Credit card number:

CVV2 code:

Card's billing address:

Expiration date:

Date:

Place:

Cardholder's signature: