EmailMe Form - BTA Credit Card Authorization Form

BTA Credit Card Authorization Form

Bond Travel Agency is pleased to confirm your travel arrangements. In order to finalize your arrangements, your payment information and signature on this credit card authorization form is required. Please note that charges are payable ONLY to InteleTravel.com or the specific travel supplier such as the hotel, resort, tour operator, cruise line, etc. Independent Travel Advisors may not accept and process charges through any other account, or accept checks, cash or other forms of payment.

Lead Traveler Name *
First Last
Legal name as on government issued identification.
Confirmation Number *
Please enter in your travel destination. If cruising with multiple destinations just put one location. ex: Bahamas
Trip Destination *
Please enter in your desired destination. If cruising with multiple destinations just put one location. ex: Bahamas
Date Travel Begins *
MM / DD / YYYY
Cardholder Name *
First Last
Cardholder Phone Number *
### - ### - ####
Billing Address *

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

Please enter the address that is on file with the card.
Email *
This will be used for mailing any electronic documents/itineraries.

Confirm
Payment Details
Please provide payment details below
Authorized Amount *
$ Dollars . Cents
Credit Card *

Card Number

Protected in vault Data collected via fields that have our security seal are encrypted and stored with the highest global security standard — PCI compliance. Your data is absolutely safe in Vault.
Charges To Be Applied On: *
MM / DD / YYYY
Type of Payment *
One Time Charge
Pay deposit amount below and balance to be paid in increment(s) until paid in full by due date
Cancellation Policies *
I agree that should I cancel and did not purchase trip protection that I forfeit all money paid.
Authorization of Charges *
I do authorize
I hereby authorize the Travel Advisor listed above, InteleTravel.com, or the hotel, resort, tour operator, cruise line or other travel supplier that my booking is through to charge my credit card for travel reservations.
Cardholder Signature
Clear
Date *
MM / DD / YYYY

Payment Details