Travel Payment Authorization Form

Travel Payment Authorization Form

Submit your travel details and authorize payment for your booking with Traveling The Rubi Way LLC.
Full Name (as it appears on card)

First NameLast Name
Billing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Card Type
Card Number
Expiration Date
CVV
Destination
Travel Dates
Number of Travelers
Resort/Supplier Name
Amount to be Charged ($)
Payment Type
I authorize Traveling The Rubi Way LLC to charge the amount indicated above for my travel booking. I certify that I am the authorized cardholder and understand and agree to the terms of this purchase. I acknowledge that travel insurance has been offered and understand my coverage selection.
Signature
Date

MonthDayYear
Date
Should be Empty: