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12 Jackson St. SE
Atlanta, GA 30312
(404) 681-0385 (O)
(404) 601-0163 (Fax)
niborworldtravel1@
Credit Card Authorization Form
I, Mr. Mrs. Ms. _________________________________ (Cardholder’s Name as Printed on card ) authorize Nibor World Travel, along with the wholesaler, travel/tour company _______________________________________
to charge my: VISA MASTERCARD AMER EXPRESS DISCOVER (CIRCLE ONE)
Card Number ______________________________________ Expiration Date ___________Security Code ____________
For the Amount of $ ___________________ For my trip to ___________________________________for myself and the following passenger(s): ____________________________Roommate Preference:________________________________
Date of Vacation __________________
Home Phone # __________________ Work Phone #______________________ Cell Phone # _______________________
Email Address: _________________________________________
I/We Do (OR) Do Not Accept the Optional Insurance (Circle One)
The address where the credit card bill comes to is ________________________________________________
__________________________________________________________________________________________
Signature of Card Holder _______________________________________Date ______________________
Are you a US Citizen? __________ If not, what is your nationality?_____________________________
Are there any special needs (dietary, handicaps, etc.)? _________________________________________
***ATTENTION: ALSO SEND A COPY OF THIS CREDIT CARD (FRONT AND BACK) ALONG WITH A COPY OF YOUR IDENTIFICATION PLEASE (IF PREVIOUSLY DONE FOR THIS SAME BOOKING, THERE IS NO NEED TO DO THIS AGAIN)
THE FOLLOWING IS FOR CRUISE PASSENGERS ONLY:
Date of Birth(s) ___________________________________________________________________________
Type of Cabin ________________________________
Emergency contact person and phone # while on cruise _______________________________________
Booking# (office use only)______________________________________________________
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