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.
Client Name

First NameLast Name
Billing Address Associated With Your Credit / Debit Card

Street Address

Street Address Line 2

CityState

Zip Code
Email
example@example.com
Phone Number
Format: (000) 000-0000.
TO ACCEPT OR DECLINE TRAVEL PROTECTION, PLEASE CHECK THE BOX BELOW AND YOUR PAYMENT TYPE
Payment Type
Amount
Please put in the amount you would like to pay towards your deposit or full payment.
PLEASE ADVISED:

A form has to be completed by each person using their card, so if there's 2 or more guests in paying separately, each guest completes the form. Once I receive your form, I will submit your deposit payment.

Please be sure to indicate, in the amount field, how much you are paying towards the deposit. This form of payment will be used for the full payment of your booking, which includes deposit and balance brought forward.
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.
Signature
Date

MonthDayYear
Date
Should be Empty: