LB Credit Card Authorization Form

TRAVEL PURCHASE AUTHORIZATION For Non-Website Purchases.

To complete your transaction and confirm your arrangements, your signature on this authorization is required. This form is NOT required for electronic purchases you complete yourself on our website, www.InteleTravel.com or its affiliates. Charges are payable ONLY to InteleTravel.com or the hotel, resort, tour operator, cruise line or other travel supplier. Independent Travel Advisors may not accept and process charges through any other account, or accept checks, cash or other forms of payment.

For your protection, Travel Insurance is strongly recommended and available upon request from InteleTravel.com. You can enroll online for travel protection for Medical Expenses, Baggage Delays/Loss, Trip Delay or Cancellation, and other coverage. Travel Escape can arrange coverage for you.

To decline recommended travel insurance, your signature on this insurance waiver form is required. Final Travel Documents (tickets, vouchers, etc cannot be sent to you prior to receipt of the signed insurance waiver.

Client Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Area CodePhone Number

PLEASE CHECK WHICH APPLIES AND SIGN BELOW*

I have ACCEPTED and authorized the travel purchases below, including travel insurance, and I am aware the insurance premium is not refundable.I have ACCEPTED and authorized the travel purchases below, and I understand that by signing below, I am DECLINING TRAVEL INSURANCE. I have read and understand all cancellation charges and change fees related to the above travel arrangements, and that I may not be entitled to a full refund should my travel plans change. In case of cancellation of nonrefundable airline tickets or other arrangements, I agree to pay all applicable penalties according to the travel supplier’s rules.

Signature*

Please select payment type*

Pay in full the amount belowPay deposit amount below and balance to be paid in full by due date

Total Amount Authorized Today*

USDDescription

Payment Method
Credit	Express

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

I hereby authorize Travel Escape/InteleTravel or the travel supplier that my booking is through to charge my credit card for travel reservation and confirm that the information for the credit card and billing address is complete and accurate.

Cardholder Signature*

Date*

Date