AUTHORIZATION FORM

CREDIT CARD AUTHORIZATION FORM

Travel by Gloria
TRAVEL AGENT INFORMATION

Gloria Atcheson/ P401830 / (812) 233-0022
Thank you for choosing Travel by Gloria for your travel arrangements. We are an independent agent with InteleTravel.com. To complete your transaction and confirm your arrangements, your signature authorization is required. 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 accounts (e.g., PayPal, CashApp, Zelle), or accept checks, cash or other forms of payment.

By completing this authorization, you are confirming your instructions for Travel by Gloria to purchase travel arrangements using the provided credit card.
CARD HOLDER INFORMATION
Cardholder Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email
example@example.com
I, the undersigned cardholder, authorize InteleTravel and or the travel supplier to charge the credit card for the transaction(s) described on this form. I understand that in the event of cancellation, a penalty may be assessed. This includes, but not limited to, the penalty associated with non-refundable payments.
Please specify the details of your purchase, including departure and return dates, name of hotel/resort or cruise ship, any reference numbers (e.g., confirmation, booking), and a brief description of the items or services you are authorizing.*
Frequency of Charges*

One Time Deposit PaymentOne Time Payment on the BalanceOne Time Charge Now and Recurring Charges Until Balance is Paid in FullRecurring Payments until Balance is Paid in Full
Transaction Amount Authorized For One-Time Payment*
One-Time Payment Date To Apply Charge(s)*

MonthDayYear
What date would you like for us to apply the charge?
RECURRING CHARGES:

I, the undersigned cardholder, have ACCEPTED and AUTHORIZE recurring charges to my credit card. I have been informed that I can cancel the recurring payment by phone at least 15 days before payment is due.
Recurring Amount Authorized*
Recurring Charge Frequency*

MonthlyBi-MonthlyBi-WeeklyQuarterlyOther
Recurring Charge Start Date*

MonthDayYear
What date would you like for us to begin the recurring charges?
Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code
I, the cardholder, hereby ACCEPT and AUTHORIZE the travel transaction identified above and confirm that the information for the credit card and billing address is complete and accurate.
Date*

MonthDayYear
Cardholder Signature*

Clear
IMPORTANT: Please attach a legible copy of the front and back of your credit card.

The travel agent listed above in an Independent Travel Advisor with InteleTravel. All rates subject to restrictions, availability and change. See www.InteleTravel.com for complete terms and conditions. InteleTravel.com is registered with the States of Florida (ST-32452), Washington (602-735-106), California (209-1941-40), Iowa (977), and Hawaii (TAR 6732) as a seller of travel. InteleTravel.com uses the personal data you disclose about yourself on this form only for the purpose of processing your requested travel purchase. We retain your personally identifiable data only as long as that processing requires. We do not share any of your personal data with any third party except for the purpose of completing your purchase, and then only with third-party travel providers and credit card processors who protect and only process your personal data for the limited purpose of this travel purchase. Following the completion of your travel that is the subject of this transaction, your personal information shall be securely destroyed unless InteleTravel.com is required by law to retain it, and then it will be retained only for that limited legally required purpose. For complete details regarding the protection of your personal information, please see InteleTravel.com’s Privacy Policy posted at www.inteletravel.com.
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CREDIT CARD AUTHORIZATION FORM

TRAVEL AGENT INFORMATION

CARD HOLDER INFORMATION