Credit Card Authorization Form, Acknowledgement of Cancellation Policies, and Travel Protection Waiver

Credit Card Authorization Form, Acknowledgement of Cancellation Policies, and Travel Protection Waiver
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, https://trips.memorymakersta.com/, or its affiliates. Charges are payable ONLY to the hotel, resort, tour operator, cruise line or other travel supplier. as described below. Independent Travel Agents may not accept and process charges through any other account, or accept checks, cash or other forms of payment.

TRAVEL PROTECTION WAIVER For your protection, Travel Protection is strongly recommended and available upon request from Memory Makers Travel Agency, LLC. You can enroll for travel protection for Medical Expenses, Baggage Delays/Loss, Trip Delay or Cancellation, and other coverage. Memory Makers Travel Agency, LLC can arrange coverage for you. For an insurance quote and purchase, please contact your travel agent.

To decline recommended travel protection, your signature on this waiver form is required. Final travel documents (tickets, vouchers, etc.) cannot be sent to you prior to receipt of the signed waiver.
Client Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Format: (000) 000-0000.
I have ACCEPTED and authorized the travel purchases below, including travel protection.I have ACCEPTED and authorized the travel purchases below, and I understand that by signing below, I am DECLINING TRAVEL PROTECTION. 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

Powered by Jotform SignClear
Pay in full the amount belowPay deposit amount below and balance to be paid in full by due date

Payment Amount*

USDDescription

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

I hereby authorize Memory Makers Travel Agency, LLC 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

Powered by Jotform SignClear
Date

MonthDayYear
Date
Should be Empty: