Credit Card Authorization Form

Credit Card Authorization Form

Let Me Help You... Travel The World Luxury Getaways
First and Last Name
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Independent Travel Advisor
Advisor's PIN
Advisor's Tel
TRAVEL PURCHASE AUTHORIZATION

I, Jazmine Williamson is pleased to confirm the following travel arrangements. To complete your transaction and confirm your arrangements, your signature on this authorization is required.
I,
First and Last Name
authorize Jazmine Williamson and or this travel supplier:
Airline, Cruise Line, Hotel/Resort, Rental Car, and or Entertainment Supplier
to charge my,
Types of Payment

Other
Credit Card Number
Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
CVC
Billing Address
For the amount of
Total Amount of Transaction
Date of Travel

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date of Travel

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Booking Number:
Flight, Rental Car, Stay, Cruise, and/or Entertainment
I have ACCEPTED and authorized the travel purchases above.

Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
IMPORTANT: Please attach a legible copy of the front and back of your credit card.

All rates subject to restrictions, availability and change. Jazmine Williamson uses the personal data you disclose about yourself on this form only for the purpose of processing your requested travel purchase. I retain your personally identifiable data only as long as that processing requires. I do not share any of your personal data with any third party except for the purpose of completing your purchase, and then only with third-party travel providers and credit card processors who protect and only process your personal data for the limited purpose of this travel purchase. Following the completion of your travel that is the subject of this transaction, your personal information shall be securely destroyed.
Upload Front and Back of Credit Card

Cancelof
Should be Empty: