GloBal Xscapes, LLC Credit Card Authorization Form

GloBal Xscapes, LLC Credit Card Authorization Form
TRAVEL PURCHASE AUTHORIZATION
To comfirm your arrangements and complete your payment transaction, your signature on this authorization form is required. Charges are payable ONLY to the supplier for your reservation. Independent Travel Agents 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 for all travel and available upon request from GloBal Xscapes, LLC. You can enroll for travel protection for Medical Expenses, Baggage Delays/Loss, Trip Delay or Cancellation, and other coverage. GloBal Xscapes, LLC can arrange coverage for you.

To accept or decline recommended travel insurance, please check one of the boxes below.
Client Name*

First NameLast Name
Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Phone Number*
PLEASE CHECK WHICH APPLIES AND SIGN BELOW*

I have ACCEPTED and authorized the travel purchase, including travel insurance and I am aware the insurance deposit is not refundable.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. I agree to pay all applicable penalties according to the travel supplier’s rules.
Payment Type*

Pay deposit amount to confirm reservation and balance to be paid in full by the final due datePay deposit amount, including Travel Insurance, to confirm reservation and balance to be paid by the final due date
Amount *
Credit Number*
Expiration Date *
CVV*
I hereby authorize GloBal Xscapes, LLC to charge my credit card for my travel reservation and confirm that the information for the credit card and billing address is complete and accurate.
Cardholder Signature*

Clear
Date

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Date
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