Credit Card Authorization

For your protection, each time you authorize us to charge an amount to your credit card, we require you to complete and sign this form indicating your approval to debit your credit card with the amount authorized.

All fields marked with asterisk* are mandatory

a. Are you a new client?

b. Are you an existing client with a new credit card?

c. Are you an existing client with a credit card on file?

Trip Information

My Travel Advisor^* Trip Name^*

Traveler Information

First Name^*

Last Name^*

E-mail^*

Contact Information

Salutation^*

First Name^*

Last Name^*

Phone (day)^*

Address^*

City^*

Phone (night)

E-mail^*

Province/State^*

Postal Code^*

Country

Credit Card Billing Details

Use same contact information as specified before.

Billing Information

Salutation

First Name

Last Name

Phone

Address

City

Province/State

Postal Code

Country

Credit Card Information

Currency^*

Amount to be Charged^*

Card Type^*

Card Number^*

Expiry Date^*

Security Code^* (?)

Visa / MasterCard / JCB / Switch / Solo

Flip your card over and look at the signature box. You should see either the entire 16-digit credit card number or just the last four digits followed by a special 3-digit code. This 3-digit code is your Card Security Code.

American Express Credit Card Users

Look for the 4-digit code printed on the front of your card just above and to the right of your main credit card number. This 4-digit code is your Card Identification Number (CID). The CID is the four-digit code printed just above the Account Number.

Currency^*

Amount Authorized^*

Last 4 Digits of Card^*

Billing Postal Code or Zip Code^*

Direct Travel Presents Travel Escapes

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