EmailMeForm
A-2021 PAYMENT ON EXISTING Reservation
LS Travel Agency Payment Authorization Terms & Coinditions:
As Primary Traveler On Reservation and on behalf of all guests on reservation: I understand this is a disclosure of business practices and permissive credit/debit card payment agreement for the purchase of travel services. I agree that payments may be made direct to selected travel suppliers on my behalf by LS Travel Agency; 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; for which you will be notified if the situation occurs.
FEES: I am aware there are potential Cancellation, Refund and Surcharge Policies and Fees by suppliers; I understand it is my responsibility to read and abide by the policies, terms and conditions as posted on supplier documents and agree not to dispute or chargeback any of the above signed for and acknowledge charges without proper course of action.
LS Travel Agency will not release personal information to ANY parties not listed below, unless provided in writing as an Emergency Contact and will apply due diligence in maintaining records in a secured, safe location.
Making A Payment On My Existing Reservation: You, authorize Lisa Streater of LS Travel Agency to make payment on your existing reservation using the information below.
This form CAN NOT be used if using a new credit card for payment, please submit a credit card authorization form.
Booking Location:
Travel Date:
*
MM
/
DD
/
YYYY
Credit Card Holder Required Information:
Name:
*
First
Last
(Exactly as it appears on credit card)
Middle Name:
*
As it appears on CC. Type N/A if it doesn't apply
Last 4-digits of Credit Card Used Previously:
*
List ALL traveler(s) on the reservation for which payments are being applied to the credit card last 4-digits above. Please include Full Name.
Traveler(s) Information:
I am submitting payment to be applied to the account of the above traveler.
Payment Type:
*
Payment on Existing Reservation
Payment In Full
Other explanation how to apply monies?
CREDIT CARD HOLDER TOTAL AMOUNT AUTHORIZED:
Credit Card Holder Total Amount you are authorizing for ALL traveler(s) listed above.
*
$
Dollars
.
Cents
How do you prefer to receive your final travel documents?
Mail my documents
E-Mail my documents
If the addrs. is different from the one above please provide the addrs. for mailing your travel douments.
Client other request(s)?
Please be as detailed as possible.
APPROVAL OF CHARGES:
As named Cardholder, I authorize Lisa Streater at LS Travel Agency to immediately charge my credit card the above amount including any additional payments required, as needed to complete the reserved Travel Package account for the primary travelers 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.
Signature
*
Clear
Use your "mouse" to sign your name.
Print Name:
*
First
Last
Today's Date:
*
MM
/
DD
/
YYYY
Email:
*
For receipt confirmation and any other documents reference your trip.
Lisa Streater ~ LS Travel Agency
Phone: 301-246-2496
Email: info@lstravels.com
Web: www.lstravels.com
