Credit Card Authorization Form

For your security and our records, we require you to complete and submit this form with your e-signature, authorizing us to charge your credit card, or provide a credit card guarantee, before we can secure your travel arrangements.

Upon receipt of this completed form, I will call you to obtain your full credit card number and CVV and input it directly into our secure system.

Agent Name

Full Name

Phone

Your Email (required)

Total Charge Amount

Travel Experience

Type of Card

Last 4 Digits of Credit Card

Name on Card

Billing Address

Terms & Conditions Acknowledgment: (Required) I declare I have read and understand that TravelStore and each supplier has their own Terms and Conditions, including payment policies and any cancellation penalties that may apply to my reservation, and that I have been properly apprised, understand, and agree to said conditions and cancellation penalties.

Use of Credit Card: (Optional) By checking this box, I am also authorizing TravelStore to use this credit card for trip payments I agree to, when due. TravelStore will obtain my verbal or emailed approval prior to making additional payment(s). (For international travel, currency fluctuations may affect the amount actually charged, and sometimes new taxes, fuel surcharges, or supplier adjustments, if mandated, may affect the final amount due.) If this box is NOT checked, Travelstore will send me a new credit card form to sign each time a payment is required.

Please use your cursor or stylus to sign this agreement.

Date

Credit Card Authorization Form

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