Y.F.T.S TRAVEL INSURANCE PAYMENT AUTHORIZATION
CENTERPIECE EVENT & TRAVEL GROUP

By completion of this form, I authorize Centerpiece Event & Travel Group to make payments on my behalf for Travel Protection Insurance to selected suppliers for the purpose of securing my travel insurance.

I understand that Debit Cards often impose a Daily Charge Limit and multiple payments may be needed to complete the full balance due. In the event this becomes necessary, Centerpiece Event & Travel Group is authorized to process payment and will notify me of payments made.
  • CREDIT CARD INFORMATION & AUTHORIZATION

  • $ .
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  • Please use your mouse, finger or stylus to sign above to authorize payment .
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  • TERMS AND CONDITIONS:

  • Please use your mouse, finger or stylus to sign above to acknowledge and agree to the above terms and conditions.