11.09.2015 Views

THIRD PARTY CREDIT CARD AUTHORIZATION FORM

THIRD PARTY CREDIT CARD AUTHORIZATION FORM

THIRD PARTY CREDIT CARD AUTHORIZATION FORM

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<strong>THIRD</strong> <strong>PARTY</strong> <strong>CREDIT</strong> <strong>CARD</strong> <strong>AUTHORIZATION</strong> <strong>FORM</strong><br />

This is to certify that, I ____________________________________________<br />

Authorized a charge(s) my credit card ending in __ __ __ __ totaling<br />

$______________ for the payment of a trip to ____________ for the<br />

following traveler(s)<br />

____________________________________<br />

Full name of Traveller<br />

_____________________________________<br />

Full name of Traveller<br />

I have reviewed the package and itinerary, and confirm that the booking is<br />

correct. Furthermore, I fully agree to these charges and agree to be bound<br />

by all rules and regulations from my credit card company.<br />

_______________________________<br />

Signature of Client<br />

____________<br />

DATE<br />

PLEASE FAX OR SCAN/EMAIL A PHOTOCOPY FRONT/BACK OF THE <strong>CREDIT</strong> <strong>CARD</strong><br />

USED AND A VALID STATE ID OR PASSPORT<br />

PLEASE FAX THIS <strong>FORM</strong> TO (786) 522-3667

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