EmailMe Form - CREDIT CARD AUTHORIZATION

EmailMeForm

Name as it appears on your credit card. *
First Middle Last
Credit Card *

Card Number

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Client Credit Card Billing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Billing Phone Number *
### - ### - ####
Amount to be charged today *
Reason for Todays Charge *
Deposit Only
Additional Payment
Final Payment
By checking these boxes, I AGREE with these statements and authorize American Airlines Vacations to charge the credit card indicated in this authorization form. I also understand that there will be a $100 cancellation fee charged by Kristi Clabaugh, if you are unable to go on the trip, and must cancel. This payment will be charged to your credit card, before cancellation can be made. Then you will receive the refund of your booking, from American Airlines Vacations, minus the $65 per person waiver fee. *
I guarantee and warrant that I am the legal cardholder of this credit card.
*
I acknowledge that I am purchasing this trip through a travel agent and not an airline/hotel, but directly with the Travel Supplier listed on this form.
*
I have reviewed all trip details, supplier terms and conditions, and confirm that all information is correct. Any alterations to this trip may result in extra fees.
*
I was made aware and agree to all change and cancellation policies of my reservation/booking.
*
I acknowledge that it is the responsibility of the traveler to meet travel requirements for vaccination and/or testing for your trip. Further you understand that vaccination requirements can change at any time.
Signature
I authorize American Airlines Vacations to charge the credit card indicated and consent to provide an electronic signature rather than a handwritten signature in connection with my Credit Card authorization. I submit my signature by typing my name below. I understand my electronic signature will be binding as though I had physically signed this document by hand. I agree that a printout of this authorization may be accepted with the same authority as the original.
Check box to agree: *
I Agree
Electronic Signature: *
Date Time *
MM / DD / YYYY

Signature