Content.onlineagency.com



[pic]

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)______________________________________________________

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download