Card Authorization Form | Vision2Travel

Client First & Last Name

Travel Agent Name

Agent Telephone Number

This is a travel purchase authorization for non-website purchases. Thank you for choosing Vision2Travel for your travel accommodations, we are pleased to confirm the following travel arrangements. To complete your transaction and confirm your travel arrangements, your signature on this authorization is required. Charges are payable ONLY to Vision2Travel for hotel, resort, tour operator, cruise line, or any other travel supplier used for your accommodations. Independent travel agents may NOT accept payments or process charges through cash, wire payments, or checks.

Card Type

American Express

Mastercard

VISA

Discover

Card Number

Billing Address (Street, City, State, Zip)

Will you use this same card for your future payments if you are paying on a payment plan?

Yes

Paying In Full

Travel Dates

Date

Security Code

Expiration Date

Total Amount Authorized

Trip Itinerary

Your Signature

I have accepted and authorized the travel purchase above, including travel insurance and I am aware the insurance premium is not refundable.

Your form has been submitted!