Credit Card Authorization Form

Credit Card Authorization Form

Credit Card Authorization Form
Cardholder Name

First NameLast Name
ConditionText
I, {cardholderName}, as a cardholder, hereby authorize Island Breeze Luxury to charge my credit card for {conditiontext} and confirm that the information for the credit card and billing address is complete and accurate.

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.islandbreezeluxury.com, or its affiliates. Charges are payable ONLY to the vendor, hotel, resort, tour operator, cruise line, or other travel supplier. Independent Travel Agents may not accept or process charges through any other account, or accept checks, cash, or other forms of payment.

Your signature on this authorization form is required. Final travel documents (tickets, vouchers, etc.) cannot be sent to you before receipt of the signed authorization form.
Date

MonthDayYear
Date
Cardholder Signature
My Products

prevnext( X )
USDDescription
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Payment Methods

Debit or Credit Card

Should be Empty: