VBS Credit Card Authorization Form

VACATIONS by Shelly LLC

Shelly English www.vacationsbyshelly.com 1-833-3MY-VACA
Credit Card Authorization Form
BOOKING / CONFIRMATION # OR GROUP NAME
TRAVEL PURCHASE AUTHORIZATION
To complete your transaction and confirm your arrangements, your signature on this authorization is required. Charges are payable ONLY to VACATIONSbyShelly.com or the hotel, resort, tour operator, cruise line or other travel supplier.

TRAVEL INSURANCE WAIVER

Travel insurance is strongly recommended and available upon request from VACATIONS by Shelly LLC. You can enroll for travel protection for Medical Expenses, Baggage Delays/Loss, Trip Delay or Cancellation, and other coverage. VACATIONS by Shelly LLC 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
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone 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

Clear
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
Credit Card

First NameLast Name
Last 6 Digit Of Credit Card NumberExpiration MM/YY and Security Code
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I hereby authorize VACATIONS by Shelly LLC 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

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Date

MonthDayYear
Date
Should be Empty:

VACATIONS by Shelly LLC

Credit Card Authorization Form