Credit Card Authorization Form

TRAVEL ITINERARY ACCURACY

I reviewed the itinerary provided and I agree that it is accurate. It reflects the correct day and dates, proper spelling of each traveler’s name (as it agrees with government ID) and all trip information that I have requested and agreed to. I have also reviewed the cancellation policy as set forth in the documents provided. Uniglobe will assess a $50 fee for each customer-initiated change to the reservation after receipt of payment, and additional airline, hotel and/or supplier fees or fare/price differentials, may also be charged. Any change made may result in the reservation being re-priced at the rate in effect at the time of the change . A "name change" constitutes a cancellation and cancellation fees will apply.
Traveler Name

First NameLast Name
Uniglobe Consultant*
Credit Card Information*

My Payment Information is on File with the AgencyPlease see Credit Card Data Below
Card Holder*
As appears on card
Last Four Digits of Card*
9388
Zip/Postal Code*
ex. 30265
Exp. Date*
MM/YY
Amount Authorized*
Billing Address*

My Billing Address is on file with the agencyPlease see Billing Address below
Billing Address*

Street Address

Street Address Line 2

CityState/Province

Zip/Postal CodeCountry
TRIP CANCELLATION INSURANCE

I was offered trip cancellation insurance and have elected one of the following options listed below. By selecting one of these options you accept full responsibility for all travelers in your party. Note that pre-existing medical conditions may have certain restrictions regarding coverage and date of purchase. Confirmation of insurance, if any, will be sent separately.
Trip Cancellation Insurance*

Accept InsuranceDecline Insurance
By signing below and submitting this form, I authorize Uniglobe Travel Partners Atlanta to charge my credit card for the required payment amount. I understand that my information will be saved to file for future transactions on my account. I understand Uniglobe Travel Partners is not responsible for any injuries, damages or losses caused to the traveler in connection with terrorist activities, social or labor unrest or diseases including COVID-19. By signing this document, I understand I am responsible for keeping myself up to date with the most recent COVID-19 protocols.

For up-to-date travel guideline information please visit our partner's page here: Travel Health Requirements or refer to your airline's information.

I accept the terms and conditions for this agency found here: Uniglobe Travel Terms
Type Your Name*
I accept the terms and conditions for this agency found in the above link "Uniglobe Travel Terms" (By typing your name you agree to these terms and conditions).
Signature*

Clear
I accept the terms and conditions for this agency found in the above link "Uniglobe Travel Terms" (By signing your name you agree to these terms and conditions and the use of your e-signature.)
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TRAVEL ITINERARY ACCURACY

TRIP CANCELLATION INSURANCE