EmailMe Form - Cardholder Payment Authorization Form

Please complete this credit card authorization form using your name exactly as it appears on the card. Hit submit and the secure/encrypted form will be sent to The Travel Tutor. Thank you for letting us plan your trip!

EmailMeForm

I authorize The Travel Tutor to charge to my credit card the amount of *
$ Dollars . Cents
I authorize charging my card for the following services: *
Cardholder Name *
First Middle Last
Please enter your name EXACTLY as is appears on your credit card.
Billing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone *
### - ### - ####
Email *
Card Type *
Visa
Mastercard
American Express
Discover
Diners Club
VISA, MASTERCARD, DINERS CLUB & 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 field.
Authorization
I hereby authorize The Travel Tutor to charge the indicated credit card listed above for the travel services stated above. I guarantee that I am the legal cardholder for this credit card.
Signature *
Clear
Press down on your mouse or press your finger on the trackpad to create a signature.
Today's Date *
MM / DD / YYYY
Accept or Decline Travel Protection

I have been informed of the cancellation policies for these travel services and have been made aware of the benefits of travel protection. At this time, I have decided to: *
Accept Travel Protection
Decline Travel Protection
Defer Travel Protection
Please put your initials in space below to acknowledge travel protection decision. *
Additional Comments/Questions
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.

The Travel Tutor is an affiliate of KHM Travel Group. California Seller of Travel Registration # 2089491-50. Registration as a seller of travel in California does not constitute the state's approval. Agent is not a participant in the Travel Consumer Restitution Fund. Florida Seller of Travel Registration # ST37113. Hawaii Seller of Travel License # TAR 7231. Iowa Seller of Travel Travel Agency # 960. Washington Seller of Travel UBI # 602