EmailMe Form - Credit Card Authorization Form-Existing Booking

Travel Agent Name *

Today's Date *

MM / DD / YYYY

Credit/Debit *

Debit card users:
Please contact your bank to authorize the payment prior to submitting this form.

Name as it appears on card *

First Last

Card Type *

Credit Card Number *

Enter your credit card number, without dashes or spaces

***NOTE***
If we require your CVV code from the back of your card in order to process payment, we will contact you for that additional information.

Expiration Date *

MM / DD / YYYY

Enter the expiration date of the card. Choose the 1st date of the month for the day portion of the date. Example: Jun 14 expiration, choose 06/01/14

Billing Address

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

Phone *

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

Amount of today's payment *

$ Dollars . Cents

Payment amount authorized as of date above. This can be deposit, partial payment, or full/final payment.

Passenger's Name *

First Last

List the name of one of the passengers booked on this trip.

Travel Supplier *

Enter the name of the company with which your travel is booked. This will NOT be Blue Sky Adventures. It will be the company listed on your quote from us and who will be charging your card. That is who you are purchasing the trip from. This may be the name of a cruise line, Disney, Apple Vacations, Funjet Vacations, etc. If more than one, please list all companies here.

Blue Sky Adventures will pay the travel supplier on your behalf, using your card information submitted here, and at no time will we collect money directly from you.

Booking/Confirmation # *

This number can be found on the emailed trip confirmation/receipt you received from Blue Sky Adventures when you first booked the trip.

Departure Date *

MM / DD / YYYY

Email address *

Confirm email address

Additional Comments/Information:

Signature *

Clear