Credit Card Authorization Form

I First Name* Last Name* hereby authorize Prime Odyssey Travel to process the credit card information provided for the reservation details listed below:
GUEST NAME *
TRIP TYPE: (CRUISE/PACKAGE/OTHER) *
DEPARTURE DATE *

Month Day Year
Date
RETURN DATE *

Month Day Year
Date
CONTACT NAME *
Full Name
BILLING ADDRESS *
CITY *
STATE/ZIP *
E-MAIL ADDRESS *
DAYTIME PHONE NUMBER *
DATE *

Month Day Year
Date
This form is provided to you by an independent travel agent affiliate of Archer Travel.

Seller of Travel: CA 2001330-10, FL 35395
Should be Empty: