Stitched Vacay Credit Card Authorization Form

Stitched Vacations

Sonya Lamar 708-512-4545 stitchedvacations@comcast.net
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.StitchedVacations.com, or its affiliates. Charges are payable ONLY to StitchedVacations.com or the hotel, resort, tour operator, cruise line or other travel supplier.

TRAVEL INSURANCE WAIVER For your protection, Travel Insurance is Strongly Recommended and available upon request from Stitched Vacations. You can enroll for travel protection for Medical Expenses, Baggage Delays/Loss, Trip Delay or Cancellation, and other coverage. Stitched Vacations 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*

PrefixFirst NameLast NameSuffix
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState

Zip Code
PLEASE CHECK WHICH APPLIES AND SIGN BELOW*

By signing below, I have ACCEPTED and authorized the travel purchases below, including travel insurance. I am also aware that the insurance premium is not refundable.By signing below, I have ACCEPTED and authorized the travel purchases below and I am DECLINING TRAVEL INSURANCE. I have read and understand all cancellation charges and change fees related to the above travel arrangements that my travel advisor has discussed and/or emailed to me. I understand 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 the full amount of my travel bookingPay deposit or payment towards my travel booking
Payment Method*

AmexDiscoverMastercardVisa
Total Amount Authorized Today *
USD
Cardholder's Name*

First NameLast NameSuffix
Credit Card Number
Expiration Date*
Security Code*
Confirm Zip Code*
Credit Card Billing Zip Code
I hereby authorize Stitched Vacations or the travel supplier that my booking is through to charge my credit card for travel reservation in the amount noted above and I confirm that the information for the credit card and billing address is complete and accurate.
Cardholder's Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Stitched Vacations

Credit Card Authorization Form