Travel Agent Credit Card Authorization Form

Travel Agent Credit Card Authorization Form
TRAVEL PURCHASE AUTHORIZATION
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.escape-routes.com, or its affiliates. Charges are payable ONLY to the hotel, resort, tour operator, cruise line or other travel supplier. 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 and available upon request from ABC Travel Company. You can enroll for travel protection for Medical Expenses, Baggage Delays/Loss, Trip Delay or Cancellation, and other coverage. ABC Travel Company can arrange coverage for you. For an insurance quote and purchase, please contact your travel agent.

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
Client Name*

PrefixFirst NameLast NameSuffix
Email*
example@example.com
Phone Number*
Client Address*

Street Address

Street Address Line 2

CityState

Zip Code
Card Authorization*

I have ACCEPTED and authorize the travel purchases.
PLEASE CHECK WHICH APPLIES AND SIGN BELOW*

I have ACCEPTED and authorized the travel purchases below, including travel insurance, and I am aware the insurance premium is not refundable.I have ACCEPTED and authorized the travel purchases below, and I understand that by signing below, 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. 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*

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Please select payment type*

Pay in full the amount belowPay deposit amount below and balance to be paid in full by due date
Please select payment.*

Pay deposit amount belowPartial payment (Must be approved by Escape Routes)Pay in full the amount below
Total Amount Authorized*
Name on Card*
Card Number*
Expiration Date*
CCV*
Zip Code for the Card*
I hereby authorize Escape Routes by Jeffrey Walls or the travel supplier that my booking is through to charge my credit card for travel reservation and confirm that the information for the credit card and billing address is complete and accurate.
Cardholder Signature*

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Date*

MonthDayYear
Date
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