EmailMe Form - BAPS Travel Credit Card Authorization Form

Select A Payment Option: *

MINIMUM DEPOSIT is amount required today to initiate reservation. (The date of travel, number of paying guests and supplier terms will be factered in computing required deposit amounts.) This amount is included in Total Package Quote provided in Email. You MUST pay the balance in full prior to Final Due Date or if booking within 75 Days of Traveling.

Package Price

$ Dollars . Cents

Cardholder Name *

First Middle Last

Cardholder Contact Number *

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

Billing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Credit Card Options *

Visa Card

Master Card

American Express

Discover Card

VISA, MASTERCARD, DINERS & DISCOVER credit cards have a three-digit (CVV) number. It is printed in the signature panel on the back of the Visa, MasterCard and Discover cards. The verification number is the last 3 digits on the right side of the panel. AMERICAN EXPRESS credit cards have a 4 digit non-embossed number. It is printed above the account number on the front of your card. It may appear to the left or to the right, but it is always above your account number. DEBIT CARDS or if your card has no verification code, enter 0000 in the CVV/CID field.

Credit Card

I have accepted the quote given to me by Zandra Black with BAPS Travel and authorize Zandra Black with BAPS Travel usage of said credit card on my behalf for services quoted and accepted. *

I accept

I do not accept

I understand this is a disclosure of business practices and permissive payment agreement for the purchase of travel services.

I agree that payment may be made directly to selected travel suppliers on my behalf by Zandra Black with BAPS Travel; paid in prorated amounts not to exceed the sum total of approved charges. *

I agree

I understand Debit Cards often impose "Daily Charge Limits" and multiple payments may be needed to complete the full balance due.

I am aware of any potential Cancellation, Refund and Surcharge Policies and Fees by suppliers and agree not to dispute or chargeback any of the below signed for and acknowledged charges without proper course of action. I understand that Zandra Black with BAPS Travel will impose the following charges when contractually applicable: all non-insured reservations are subject to Cancellation Fees of $35 per traveler and will be applied to the provided credit card account. Zandra Black with BAPS Travel will not release personal information to ANY parties not listed on your finalized Travel Quote and will apply due diligence in maintaining records in a secure, safe location. *

I agree

Terms and Conditions

I have received, reviewed and agree to the Travel Vendor/Supplier/Operator "Terms and Conditions" for the purchase of this travel service/vacation package.
"Terms and Conditions" were included with your travel service/vacation quote. *

I agree

Any comments regarding amount to be charged to authorized credit card today:

Electronic Signature Consent

I consent to provide an electronic signature rather than a handwritten signature in connection with my Credit Card authorization. I submit my signature by typing my name below and checking the “I agree” box. I understand that my electronic signatures will be binding as though I had physically signed this document by hand. I agree that a printout of this authorization may be accepted with the same authority as the original. *

I agree

Signature *

Clear

Date Time *

MM / DD / YYYY