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Cardholder Authorization Form
Agent Name: Alyshia Steele
Agent ID: 20033261
Name that appears on the card if different from the Traveler
Name of Destination or Cruise
Traveler's Best Contact Number
Credit Card Disclosure
VISA, MASTERCARD, DINERS & DISCOVER credit cards have a three-digit (CVV) number. It is printed in the signature panel on the back of the Visa, MasterCard and Discover cards. The verification number is the last 3 digits on the right side of the panel. AMERICAN EXPRESS credit cards have a 4-digit non-embossed number. It is printed above the account number on the front of your card. It may appear to the left or to the right, but it is always above your account number. DEBIT CARDS or if your card has no verification code, enter 0000 in the CVV/CID field.
Credit Card Type
CC Expiration Date
MONTHLY RE-OCURRING PAYMENTS
Would you like Monthly Re-occuring Payments
I DO authorize to use this card for monthly payments
I DO NOT authorize to use this card for monthly payments
**If you noted above you would like to authorize re-occuring payments provide the Monthly amount to draft**
Monthly Payment Date
**If you noted above you would like to authorize re-occuring payments provide date to draft**
State / Province / Region
Postal / Zip Code
Please confirm if you elect to take travel insurance
I understand that changing any aspect of my travel arrangements may result in the payment of additional money. Travel insurance may offer protection from this and further additional benefits.THIS ALREADY MAY BE INCLUDED IN YOUR VACATION PACKAGE
I authorized Lyric’s Destinations to charge the amount above to my credit card
Your signature confirms you authorize Lyric's Destinations or one of it's supplier to debit the card information provided. Also I hereby verify that I have reviewed my travel itinerary for accuracy. I have been advised of all applicable fines imposed by Lyric's Destinations and the suppliers, plus I have been offered the option of purchasing trip cancellation insurance.