EmailMe Form - Credit Card Authorization - Kim Stumpf

Credit Card Authorization - Kim Stumpf

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 *
First Middle (or M.I.) Last
Billing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

This address must match the billing address with the credit card company.
Credit Card

Card Number

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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
Accept
Decline
Signature
Clear