Credit Card Authorization

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 Advisors 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 InteleTravel.com. You can enroll online for travel protection for Medical Expenses, Baggage Delays/Loss, Trip Delay or Cancellation, and other coverage, or your Independent Travel Advisor can arrange coverage for you.

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.

Independent Travel Advisor: Lynn Davenport PIN:P526353

Advisor Telephone: 970-302-5000

Email: Empoweredjourneytravel@gmail.com

Client Name

First NameLast Name

Email

example@example.com

Phone Number

TRAVEL PROTECTION. Please check ONE and sign below to accept or decline travel protection:*

I have ACCEPTED travel protection insurance included with the travel purchases below, and I am aware the insurance premium is not refundable.I have DECLINED travel protection insurance but I have accepted and authorized the travel purchases below, and I have read and understand all cancellation charges and change fees related to these travel arrangements. I understand 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

AUTHORIZATION for the following travel arrangements:

Check One:

AMERICAN EXPRESSMASTERCARDVISA

Authorized Purchase Details

I hereby authorize Inteletravel.com or the travel supplier that my booking is through to charge my credit card for this travel reservation and confirm that the information for the credit card and billing address is complete and accurate.

Name

First NameLast Name

Today's Date

Date

Cardholder Signature

Upload Photo of Back of Credit Card

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Upload Photo of Front of Credit Card

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. © InteleTravel.com 2020

Credit Card Authorization Form