Application Form Annual fee to Visa/MasterCard/Delta holders: œ35 FULL MONEY BACK GUARANTEE Please fill in and return to: Transmedia UK plc, FREEPOST SW8550/1, London SW1Y 4LB Tel : 0171-930-0700 Fax: 0171-930-2868 Reference : PSI01 ___________________________________________________________________________ Mr/Mrs/Other : Date of birth : First name(s) : Surname : Home Address : Postcode : Home phone : Business name : Job title : Business address : Postcode : Correspondence to : Home y/n or Business y/n Business phone : Business fax : Email address : Name of additional Transmedia cardholder (no extra charge) : VISA/MASTERCARD/DELTA Account Number Expiry Date _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ | | | | | | | | | | | | | | | | | | | | | | |_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_| |_|_|_|_| I hereby authorise Transmedia UK Plc or its assignee to debit the above listed VISA/MASTERCARD/DELTA account directly for all restaurant charges incurred by me or an authorised user and for my annual membership fee (currently œ35). I understand all restaurant charges (other than service, tip & VAT) incurred by me, or an authorised user, will be offset by a 25% credit when being debited to my credit card account. I recognise the the Transmedia card is the property of the issuer and will be returned by me upon request. Signature : __________________________ Date : __________