EmailMe Form - Credit Card Authorization Form

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Today's Date *

MM / DD / YYYY

Name *

First Middle Last

If you are paying on behalf of another traveler please list their name above. (First and Last name of traveler whom you are paying for today)

Email *

Cell Phone *

### - ### - ####

Date of Trip *

Booking Number (optional)

Please see invoice for booking number.

Reason for Payment *

Initial Deposit

Final Payment

Vacation Installment Payment/Regular

Type of Vacation *

Cruise

All Inclusive Vacation Package

United States Vacation - Vacation Package

Other

Amount authorized to debit *

Credit Card *

Visa

American Express

Mastercard

Discover

Name on card *

Card Number *

Please list a dash after every four numbers.

3 Digit Security Code (4 Digits AMEX) *

Credit Card Expiration Date *

MM / YYYY

Billing Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Terms and Conditions

I agree to the following terms & conditions. Thank you for your purchase with Vacations By Paris. To complete your transaction and confirm your arrangements, your submission of this authorization form is required. Charges are payable ONLY to the hotel, resort, tour operator, cruise line or other travel supplier designated by the above entity. I certify that I am authorized to use this credit / debit card and that I am able to make charges using this credit / debit card . I will not dispute the payment with my credit card company as long as the transaction corresponds with the terms indicated above. This payment authorization is for the goods and services described above. By my submission of this form, I give authorization to Vacations By Paris and the travel vendor being used to debit my credit / debit card for all amounts listed above ONLY. I understand that if I elect to decline Travel Insurance I am responsible for any cancellation penalties and all out-of-pocket expenses that may occur. I will also make my own provisions in the event of an emergency while I'm away if I elected to forgo travel insurance.

Signature *

Clear