Credit Card Authorization Form To purchase your vacation package, please print this form,
complete all sections and FAX to our office, 770-516-6621. If you are not able
to print this
form, we will be happy to FAX it to you. Resort Name: ____________________Room Category:__________________ Departure Date:_______________ Number of Nights:_______________ Airfare Included?________________ If yes, Gateway City:________________
Passengers Legal Names As They Appear On PASSPORT Or Proof Of Citizenship - Drivers License, Birth Certificate. 1.___________________________ 2._________________________ 3.___________________________ 4._________________________
Card Type: VISA_____ MasterCard______ AMEX______ DISCOVER______ Card Number:___________________________ Expiration Date:_________________ (required) Cardholder's Name (as it appears on card):_______________________________ Cardholder's Billing Address:____________________________________ City:_______________________________ State:________________ ZIP:_______________ Home Phone:______________________ Work Phone:____________________ FAX:____________________ Email Address:____________________________
Trip Insurance has been offered (cost to be determined upon Tour Operator used at time of deposit/final. Insurance is non-refundable). Cost of Trip Protection Insurance per person $_______________ Please Initial that you:___________ Accept or ___________ Decline Total Package Price $___________________ We/I hereby authorize eTravelAway.com and the representative Tour Operator to charge my / our vacation package in the amount of $___________________to my/our credit card. Cardholder's Signature:_________________________ Date:____________________ We must have this form signed and faxed to us before we can book your vacation package. If you are purchasing your vacation package with a check, please make check payable to eTravelAway and mail check to: eTravelAway.com Copyright© 1999
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