Payment Authorization Form
Please complete this form to authorize payment.
Authorized card holder information
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Choose One One-time use only – This authorization is valid for a single transaction. Ongoing authorization – This card may be used for future transactions with prior written approval each time.
One Time use Only
Ongoing
Authorization
I, the undersigned cardholder, authorize Kathy Newsome Wander Company LLC, its agents, and authorized travel suppliers to charge my credit card for agreed-upon travel purchases. I understand that this authorization is for the purpose of securing travel reservations as requested by myself (or the traveler named above). I acknowledge that I will be informed of each charge prior to processing and that I will receive a full breakdown of the charges to be submitted. I understand that the travel suppliers will process all charges and that Kathy Newsome Wander Company LLC is acting solely as a booking agent. Chargeback Policy & Acknowledgment By signing this form, I confirm that I have authorized these travel charges and will not dispute or attempt to charge back any charges associated with this travel purchase for services that I have knowingly and willingly authorized. I understand that any disputes regarding service, cancellations, or refunds must be handled directly with the travel supplier, and that I am responsible for reviewing and understanding all applicable terms and conditions. In the event of a billing error or unauthorized charge, I agree to notify Kathy Newsome Wander Company immediately so the issue can be resolved promptly and professionally.
Please provide your digital signature to authorize the payment.
*
Send Authorization Request
Send Authorization Request
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