EmailMe Form - Credit Card Authorization Form- Kayla Castro

Briar & Main Travel Boutique, LLC is an approved travel agency authorized to conduct business with all travel suppliers including, but not limited to airlines, car rental agencies, hotels, cruise lines, tour operators, and travel insurance companies. Your professional travel agent is contracted with Briar & Main for the purchase of these various travel services, therefore, it is required that you comply with our credit card acceptance policies. You should complete this form if you are using your credit card to purchase travel services for yourself or other individuals known to you. Please fully complete this form using the instructions provided below. The purpose of this Credit Card Authorization form is to comply with credit card acceptance rules with travel suppliers and to protect you the cardholder, Briar & Main Travel Boutique, LLC and your travel agent from credit card fraud. If you have any questions or concerns regarding this form, please contact your travel agent or Briar & Main Travel Boutique, LLC at 520-848-4257. This form must be completed and signed by the cardholder. Briar & Main Travel Boutique, LLC reserves the right to request additional information from the cardholder. If fraud is suspected, Briar & Main Travel Boutique, LLC reserves the right to deny this transaction.

Cardholder's Name *

First Last

If using more than one credit card, please put the amount for this card in the space indicated and enter the second card below under "additional comments".

Email *

email@email.com

Phone *

### - ### - ####

Billing Address *

Street Address City State / Province / Region Postal / Zip Code

Type of Payment *

Deposit

Payment

Final Payment

Amount to charge *

$ Dollars . Cents

Credit Card

I authorize Briar & Main Travel Boutique, LLC to charge the credit card for the noted amount on today's date. I understand that my right to a refund in the event of cancellation is governed by Briar & Main Travel Boutique, LLC’s Terms and Conditions of Booking as well as the supplier's. I certify that I am an authorized user of this credit card, that I agree to Briar & Main Travel Boutique, LLC's Terms and Conditions (www.briarandmaintravelboutique.com/termsandconditions) of Booking, and that I will not dispute the payment with my credit card company so long as the transaction corresponds to the amount and terms on this form.

By signing below, I authorize Briar & Main Travel Boutique, LLC to charge the credit card provided herein.

Signature (sign with mouse, stylus, or finger) *

Clear

Today's Date *

MM / DD / YYYY

Authorization of Future Payments *

I authorize this card for future payments

I want to use a different card for future payments

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.

*FIRST PAYMENTS*
Please list the full names and ages of guests traveling in your party!