CREDIT CARD AUTHORIZATION FORM

US RoadTrip Order Form

Daiquiri Tours is requesting authorization from the card holder to charge your credit card for travel-related purchases. By filling out and signing this form you grant permission to Daiquiri Tours to do so for the services listed below, which are services that you have requested to purchase. In some cases, charges on your card may appear from third parties used by Daiquiri Tours to fulfill your travel-related services.
Select Your RoadTrip Program ($249 per itinerary)
Would you like to add on any additional customized days for $40 per day?

YESNO
If yes, please provide us with the details about your additional days or requests here. Note that we will not charge your card until we have reviewed this custom request with you to determine the best options for you.
Full Name (as it appears on the card)

First NameMiddle NameLast Name
E-mail
Billing Phone Number

Area CodePhone Number
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Credit Card

VisaMastercardAmerican ExpressDiscover
Number of Travelers
Travel Date

MonthDayYear
Departure date
Any special requests or additional information we should know?
Would you like for us to assist you in booking your travel-related services (such as flights, hotels, car rental, tours, etc.)? If yes, we will contact you to review options and will not charge your card without your approval or authorization.

YES, please call me to discuss.NO, I am making my own travel arrangements.
We stronlgy recommend purchasing travel insurance to protect your investment. Shall we send you a quote?

YES, please send me a quote.NO, I understand that I may not be eligible for emergency assistance or refunds if I do not purchase travel insurance.ALL SET, I have already purchase travel insurance.
I agree to purchase the above travel-related services and agree to pay for these services with the above credit card. I understand that the payment may come from a third party contracted by Daiquiri Tours to fulfill my travel-related services, and in some cases multiple charges may be applied.

I agree to all terms and conditions and understand that a refund may not be possible after the travel services are confirmed. ALL FLIGHTS purchased are subject to the airline's policies, and not Daiquiri's terms and conditions, and in most cases are non-refundable/non-changeable tickets.

In order to travel internationally you must have a valid passport (in some countries valid for at least 6 months of your return date) and visas (where applicable) and I understand that it is my responsibility to obtain such travel documents prior to my travel date.
Signature*

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please use your mouse of finger to sign on the line
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US RoadTrip Order Form