CREDIT CARD AUTHORIZATION

CREDIT CARD AUTHORIZATION
Complete the form below with the following information to complete your request.
Name (enter exactly as it appears on your card)*

First NameMILast Name
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Personal Email*
Phone Number*

Area CodePhone Number
Last 4 digits of credit card to be used for payment*
Dollar amount to be charged for this transaction*
I authorize WISHING ON A STAR TRAVEL, LLC to charge my card referenced above in the amount indicated and agree to Wishing on a Star Travel's terms and conditions of this booking, which are located at this link, including suppliers' and agency's cancellation and refund policies, which may limit my right to a refund if I cancel or change my plans.
Signature*

Use the mouse to draw your signature
Enter your TRAVEL AGENTS email address*
example@example.com
Date*

MonthDayYear
Date
Should be Empty: