EmailMe Form - Credit Card Authorization Form

Company Name *
Billing Address *

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

Please enter the address that is on file with the card.
Cardholder Phone Number including country code *
Email *
This will be used for mailing any electronic documents/itineraries.

Confirm
Payment Details
Please provide payment details below
Name of Card Holder *
First Last
Legal name as on government issued identification.
Date of Birth
DD / MM / YYYY
Please enter Date of Birth of Card holder
Card Type *
This will be used to secure payments.
Credit Card *

Card Number

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Authorisation of Future Payments *
This Credit Card Authority is a standing Authority and will apply in respect of all transactions between THE AGENT and the Card Holder from the date of this authority until the authority is revoked by notice in writing by the Card Holder to THE AGENT
The Card Holder utilizes the services of SPENCER GROUP OF COMPANIES PTY LTD (‘THE AGENT’) on a continuous basis for the Card Holders travel requirements.

In order to facilitate payment for travel arrangements between the Card Holder and THE AGENT, the Card Holder confirms that all orders placed with THE AGENT are to be charged to the Card Holders credit card or cards circled below. If more than one credit card is noted by the Card Holder, then the Card Holder will advise THE AGENT of which card to utilize in relation to each order, but if no direction is given in that regard, THE AGENT is authorized to charge the order against the Card Holder’s credit card as nominated as one (1) on the list.

THE AGENT reserves the right to obtain proof of identification in the form of a copy of a signed drivers license, passport or photo ID to verify identity of the Card Holder.

PRIVACY STATEMENT - “I/We acknowledge that I/we will provide Spencer Travel Pty Ltd (‘THE AGENT’) from time to time with information about myself / ourselves of a personal nature (personal Information”).
Required *
ACCEPT:I/We (Client) consent to ‘THE AGENT’ using any personal information supplied by me/us for the purposes of making and completing airline bookings and travel related arrangements on behalf of me /us.
Signature *
Clear
Date Time *
DD / MM / YYYY

Payment Details