LB Credit Card Authorization Form

Tia's Travel Suite

Tia Glenn 713-548-3612 tia@tiastravelsuite.com
Credit Card Authorization Form

Your signature approves Tia's Travel Suite to authorizie payment on your behalf all information will be kept confidential.
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 Agents may not accept and process charges through any other account, or accept checks, cash or other forms of payment.

TRAVEL INSURANCE WAIVER For your protection, Travel Insurance is STRONGLY RECOMMENDED and available upon request from Tia's Travel Suite. You can enroll for travel protection for Medical Expenses, Baggage Delays/Loss, Trip Delay or Cancellation, and other coverage. Tia's Travel Suite can arrange coverage for you. For an insurance quote and purchase, please contact your travel agent.

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
Phone Number

Area CodePhone Number
Email
example@example.com
Date of Birth (05/01/1980)
PLEASE CHECK WHICH APPLIES AND SIGN BELOW

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

Total Amount Authorized Today

USDDescription

Payment Method
Credit	Express

Cardholder
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 Tia's Travel Suite/InteleTravel or the travel supplier to charge my credit/debit card for travel reservation and confirm that the information for the credit/debit card and billing address is complete and accurate. I also confirm that I am authorized to use the card for this travel transaction and acknowledge that I will be required to send a clear photo of identification and credit card being charged. Email required information to tia@tiastravelsuite.com.
Cardholder Signature
Date

MonthDayYear
Date
Should be Empty:

Tia's Travel Suite

Credit Card Authorization Form

Total Amount Authorized Today