EmailMe Form - PAYMENT AUTHORIZATION FORM

PAYMENT AUTHORIZATION FORM

PJM Vacations/Linda Rubino (781) 603-3857

I understand this is a disclosure of business practices and permissive payment agreement for the purchase of travel services. I agree that payments may be made direct to selected travel suppliers on my behalf by PJM Vacations; paid in prorated amounts not to exceed the sum total of approved charges. I understand Debit Cards often impose “Daily Charge Limits” and multiple payments may be needed to complete the full balance due. I am aware of any potential Cancellation, Refund and Surcharge Policies and Fees by suppliers and agree not to dispute or chargeback any of the above signed for and acknowledged charges without proper course of action. I understand that PJM Vacations will impose the following charges when contractually applicable: all non-insured reservations are subject to Cancellation Fees of $35 per adult, and when applicable, Booking Transfer Request Fees of $90 per adult will be applied to the provided credit card account. PJM Vacations will not release personal information to ANY parties not listed on your finalized Travel Contract and will apply due diligence in maintaining records in a secured, safe location.
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Primary Travelers Name *
Prefix First Last Suffix
I am submitting payment, to be applied to the account of the above Primary Traveler, whom is able to dictate dates, cost and details of the applicable reservation code below.
List ALL guests on Reservation for which payment is being applied.
Include complete FULL NAME and DATE Of BIRTH for guests *
I am submitting payment, to be applied to the account of the above Travelers, for whom is able to dicate dates, cost and details of the applicable reservation code below.
Agreed Total Package Cost
This is the Total Package Quote, which includes anticipated payments to be prorated to various suppliers; such as airlines, hotel, cruiseline, resorts, insurance, excursions and guest services-as dictated in the Quoted Travel Package. Each identified charge will be confirmed by email on date prior to payment submission and confirmed by paid receipt. This amount subject to change with any additions/removal of travel activities.
Name As It Appears On Credit Card *
Prefix First Last Suffix
Cardholders Billing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Email *
Cardholder's Phone *
### - ### - ####
Card Type *
Credit Card Number *
Card Expiration "mm/yy + 3 Digit/CCV Code" *
Deposit/or Amount Authorized Today
$ Dollars . Cents
Deposit is minimal amount required today to initiate reservation. The date of travel, number of paying guests and supplier terms will be factored in computing required deposit amounts. This amount is included in Total Package Estimate.
Approval of Charges *
As named Cardholder; I Authorize: PJM Vacations/Travel Agent Linda Rubino to immediately charge my credit card to the multiple suppliers if required, to complete the reserved Travel Package account for the Primary Traveler listed above.
Future Payment Authorization
I will authorize By EMAIL, all future payments due towards Total Package Cost, to be charged to the above credit card with the same terms as disclosed. I may opt to use a different Credit Card simply by submitting a new Authorization Form.
Email for Receipt & Confirmation
Initial to authorize PJM Vacations to charge your credit card. *
Electronic Signature *
Clear