Travel Agent Credit Card Authorization Form

Travel Agent Credit Card Authorization Form

Please complete this form to authorize the processing of your payment.

Client Information

Name

    Email

      Phone number

        Address

          Reservation Details

          Booking Reference Number

            Travel Insurance

            Please indicate if you would like to add travel insurance to your booking:

              • Yes, I would like to add travel insurance.

              • No, I decline travel insurance.

              Authorization

              I hereby authorize [Your Company Name] or the travel supplier that my booking is through to charge my credit card for the travel reservation. I confirm that the credit card and billing information provided is accurate and complete.

              Name:

              Date:

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