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Credit Card Authorization Form For
Discount Charter Vacations.com |
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| For your
convenience, this Authorization gives Happy Landing Travel Agents the
authority to make charges in the minimum
amount of $___________ maximum amount of $_________ with all conditions of sale as if you
were presenting your credit card in person. Print out this form
and fax it to us at (724) 733-2427. Include
a copy of the front and back of your credit card, PLUS a copy of your passport or a photo
i.d. such as your military id or drivers license. Your reservation
will not be processed until this completed authorization is received and
if not received within all applicable deadlines your booking may be
automatically cancelled. If you prefer to mail the completed form, send it to: Discount Charter Vacations, 910 Presque Isle Plaza, Route 286, Pittsburgh, PA 15239. PLEASE NOTE: If you have traveled with us before and we have a copy of your photo id on file, you can complete a secure version of this form. Go here to complete and submit it on line. |
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MY
SIGNATURE BELOW DENOTES MY ACCEPTANCE OF THE FOLLOWING:
Persons Authorized for Travel In Your Group: ( print the names as they appear on the passport or photo id) |
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| 1. ____________________________________ | 5. ________________________________ |
| 2. ___________________________________ | 6. ________________________________ |
| 3. __________ _ | 7. ________________________________ |
| 4. ___________________________________ | 8. ________________________________ |
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Contact Person:
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Your Name |
_________ |
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Address (as on credit card):
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_________ |
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City, State, Zip
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_________ |
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Day Phone
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Evening Phone
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Cell Phone
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Email Address:
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My Airline Membership Number |
____________________________________ |
| Deliver Documents To: | |
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Deliver to Street Address:
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_____________ |
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Deliver to City, State, Zip
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_________ |
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If you are getting an E-ticket there will be no additional charge. If you are requesting a paper ticket, we will send your ticket by 2nd day air service, and your credit card will be billed $11 - $13 depending upon your zip code.We can not send tickets to a PO Box address!! |
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| Trip Details: | |
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Reservation Number:
_______________________ Per Person Rate (without
insurance):___________ Maximum Amount Authorized for this transaction: ___________________________________
Initial here
________ to
add travel insurance to your vacation. |
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| This payment of $ __________ (US Dollars) represents a deposit _____ or payment in full ____ for Airline tickets ___ Tour package ____ Hotel / Lodging accommodations ____ Charter vacation package___ Cruise ___ Disney Vacation ___ Other: (details)_______________________________________________ | |
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Tape your Photo ID with your address and signature |
| PLEASE NOTE: The name on your credit card and Driver’s License must match. The billing address must match the Driver’s License address. |
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| Credit Card
Type: MasterCard _____ Visa _____ Discover______
American Express____ JCB___ Credit Card Number: ______________________________ Exp. Date:__________ CVV# ________ ( 3-digit code at the end in the signature panel on your Master Card, Discover or Visa. It is a 4-digit code on the front of your American Express card.) |
| Cardholder's Billing Street Address: ____________________________________________________________ |
| Company (if applicable): ____________________________________________________________ |
| Suite/Apt. No.: ____________________________________________________________ |
| City:______________________________________________________________________ |
| State/Province/District: __________________________________ Zip/Postal Code: ______________________ |
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Billing Address Phone:
__________________________
Fax: _______________________________ Country: _________________________________ Alternate Phone:_______________________ |
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Authorized Signature:
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________________________________________________________________________ |
| In lieu of my credit card imprint, I hereby authorize Happy Landing Travel d.b.a. Discount Charter Vacations. com to charge my credit card with the pre-authorized amount to reserve and pay for my trip . By signing this authorization form, I agree to be financially responsible for the above charges and/or the total amount incurred for the airline tickets, travel or vacation package of my choice even though I have not signed the original charge receipt, voucher or note. Further, I warrant and represent that I have the authority to enter into this contract and use the credit card above. I hereby designate an authorized user (named above) to make charges on this card for this trip only in the event that I am personally unable to do so. I hereby agree to indemnify and hold blameless Happy Landing Travel, Inc. Discount Charter Vacations for any and all unauthorized charges, claims and liability related hereto. I agree that Discount Charter Vacations.com is not responsible if my Passport or Visa is denied by authorities in the country I plan to visit. I agree to immediately notify Happy Landing Travel of any changes to the identity of Authorized User or persons listed above. I understand that payment in full to be made before my trip begins I fully understand the airline tickets and other travel services or products are non-refundable and/or are subject to penalty fees in the event changes need to be made or services and/or products need to be cancelled. I do understand that there will be penalty applied for changes or a refund requested once the ticket has been issued. I have read and do understand your terms and conditions. | |
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Photocopy this form after all information is
filled out, signed and dated. Or fax the completed
copy to us and retain for your records. |