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Credit Card Authorization - Nancy Long
I have accepted the quote given to me by GETAWAY TRAVEL COMPANY, LLC and authorize GETAWAY TRAVEL COMPANY, LLC usage of said credit card on my behalf for services quoted and accepted. 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 GETAWAY TRAVEL COMPANY, LLC; 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.
Name as it appears on credit card
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First Middle (or M.I.) Last
Billing Address
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Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
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Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
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Ecuador
Guyana
Paraguay
Peru
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Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
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Ukraine
United Kingdom
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Myanmar
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East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
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North Korea
South Korea
Kuwait
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Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
This address must match the billing address with the credit card company.
Credit Card
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Card Number
Expiration
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CVV
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3 or 4 digit number printed on the back/front of your credit card
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Amount I wish to pay on booking:
Deposit Only
Deposit & Insurance
Final Payment
Other
Other Amount
Comments
New DOT Consumer Airline Protection Rules
(effective 2/26/2012)
I understand that the airline tickets or air tours I am purchasing are subject to supplemental price increases that may be imposed after the date of purchase. Post-purchase price increases may be applied due to additional costs imposed by a supplier or government. I acknowledge that I may be charged additional sums by Getaway Travel Company, LLC to offset increased fees, fuel surcharges, taxes, fluctuation in foreign exchange markets or any combination thereof. I hereby consent to any post-purchase price increases and authorize Getaway Travel Company, LLC to charge my credit card for such additional amounts.
I accept / decline terms of agreement
Accept
Decline
GETAWAY TRAVEL COMPANY, LLC HAS MY PERMISSION TO CHARGE MY CREDIT CARD TOWARDS MY VACATION EACH TIME I GIVE PERMISSION EITHER BY EMAIL/PHONE/VERBAL
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Decline
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