Card Authorization

OA: CC Authorization

Step 1 of 2

Your completion of this authorization form helps us protect you, our valued customer, from credit card fraud. All information entered on this form will be kept strictly confidential. You must provide a clear copy of cardholder's picture ID or by return of this form alone your travel advisor is acknowledging that you are known to him/her.
Cardholder Name*
First Last
Must match your credit card and government issued ID.
Invoice Number*
Cardholder's Billing Address including State and Zip Code*
Credit Card Type*
Last 4 digits of card*
Expiration Date*
mm/yy only. 5 characters total.
Total to be Charged*
Please enter a number greater than or equal to 0.

I, {:3.1} {:3.2} the individual identified as "Cardholder Name" above, authorize the agent or agency providing this form from this website, or their authorized representative, to charge my credit card listed on this document for the travel related charges above. I understand all the terms and conditions of this booking and agree to the terms and conditions provided to me for this travel arrangement, including all cancellation policies. I understand and agree that travel arrangements may be subject to non-refundable cancellation penalties. I agree to carefully read all emailed communication between and myself and note all restrictions that may apply. I further understand that as part of your travel services, you recommend that all travelers purchase some form of travel insurance to help protect their travel investment. I, the above-named Cardholder or authorized representative, certify that the information provided on this form is true and correct. I am authorized to effect charges on the credit card number provided. I agree that in the event of a discrepancy to my credit card account, I will notify your agency's accounting department within seven (7) business days of receiving the credit card statement or immediately upon knowledge of such error. {created_by:display_name}
Untitled*
- As the credit card holder, I extend this authorization to include purchases verbally approved by me for 90 days from today's date.
- As the credit card holder, I do NOT extend this authorization to include purchases verbally approved by me for 90 days from today's date.
Electronic Consent*
- I agree to Electronic Consent
We use electronic documents to obtain consent and to notify you of important information regarding your transactions with us. Please check the box below to agree to electronic communications as defined here. Otherwise, please call us at the number at the top of the page.
Signature
Type Your First and Last Name*