Credit Card Authorization & Travel Insurance Form

Credit Card Authorization & Travel Insurance Form
To complete your transaction and confirm your arrangements, your signature on this authorization is required. Charges are payable ONLY to the agency, hotel, resort, tour operator, cruise line or other travel supplier. Independent Travel Agents may not accept and process charges through any other account, checks, cash or other forms of payment.
Client Name*

First NameLast Name
Email Address*
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Please Select Payment Type*

Pay in full the amount belowPay deposit amount below
Total Amount Authorized*
Please provide the the credit card number you authorize us to charge (For your protection, please email ONLY the expiration date and CVV to brenee@bookwithbre.com)*
Travel Insurance*

I have ACCEPTED and authorized the cost of travel insurance and I am aware the insurance premium is not refundable.I am DECLINING travel insurance. I have read and understand all cancellation and change fees related to my travel arrangements and that I may not be entitled to a full refund, should my travel arrangements change. In the case of non-refundable arrangements, I agree to pay all applicable penalties according to travel supplier’s rules.
I hereby authorize Book With Bre or the travel supplier of my booking to charge my credit card for the reservation and confirm that the information provided is complete and accurate.
Signature*

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