CREDIT CARD PAYMENT AUTHORIZATION
Fax Form with copy Credit Card and Driver's License to 301-593-6991
 CARDHOLDER
  NAME  EXACTLY as on card
Cardholder must be one of the passengers travelling
  CREDIT CARD NUMBER       
  CREDIT CARD EXPIRATION & CARD ID   Exp:    Card ID:   what's this?
 

STATEMENT BILLING ADDRESS

CITY/ STATE/ ZIP

  
  STATEMENT BILLING TELEPHONE #  
 RESERVATION DETAILS
  TRAVEL AGENCY  
  TOUR OPERATOR or CRUISE LINE  
  BOOKING# or GROUP NAME       
  DESTINATION  
  HOTEL or SHIP NAME  
  DEPART DATE  
  RETURN DATE  
  TRAVEL INSURANCE
(please choose Accept or Decline)
  . No box checked = trip insurance declined.
 
  NAMES OF ALL TRAVELERS
  for whom this payment is made		  
 PAYMENT
  TRIP PAYMENT   US$ TO BE CHARGED NOW
  CHARGE TRIP INSURANCE   US$ WITH INITIAL DEPOSIT
       No payment included = trip insurance declined
  AUTOMATICALLY CHARGE BALANCE   US$ ON FINAL PAYMENT DUE DATE

ITINERARY ACCEPTED. By signing below, I acknowledge receipt of the itinerary for the charges indicated above. I have checked and verified the itinerary, including all traveller names, travel dates and flight details where applicable. I have read and understood the change, cancellation, and other important booking information detailed with my Confirmation Invoice and I understand that change and cancellation penalties apply. I authorize TWG Travel & the tour operator or cruise line named on the itinerary to charge my credit card on behalf of the associated suppliers for the charges detailed. If Airline reservations are included in my travel, I understand that total billing may be split between the airline(s) and the tour operator or cruise line merchant. I agree to make payment for the above charges when billed by my credit card issuing company. I have attached a copy of my credit card (back and front) and a copy of my driver’s license.

  CARDHOLDER SIGNATURE        DATE
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