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 Consultant
Name
Credit Card Information *

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

My Billing Address is on file with the agency Please see Billing Address below
Billing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
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 Insurance Decline 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
Signature *

I accept the terms and conditions for this agency found here: Uniglobe Travel Terms Clear
Should be Empty:

TRAVEL ITINERARY ACCURACY

TRIP CANCELLATION INSURANCE