EmailMe Form - Credit Card Authorization Form

Traveler Full Legal Name *
First Middle Last
Legal name as on government issued identification.
Date of Birth
MM / DD / YYYY
Please enter Date of Birth for Primary Passenger
Billing Address *

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

Please enter the address that is on file with the card.
Mailing Address if different from Billing

Street Address City State / Province / Region Postal / Zip Code Country / Region
Cardholder Mobile Phone Number *
### - ### - ####
Please use a number where you can receive SMS
Email *
This will be used for mailing any electronic documents/itineraries.

Confirm
Trip Destination or Group Name *
Traveling with others and paying on the same card?
List as it appears on their legal ID,
full legal name date of birth and gender (M or F)
Loyalty & KTN numbers
If you or anyone traveling with you has KTN and/or frequent flyer awards numbers please indicate with name & number.
This may be added later if you don't have it now.
File Upload *

Add File

Copy of Credit Card Front/Back
DL & Passport for each traveler.
If the card being used is not in a traveler's name, please upload card holders ID as well.
Files are encrypted.
Should we keep your information on file after your trip? *
YES
NO
Travel protection covers more than just your flights. *
YES
No - by selecting this option, you are electronically signing a waiver declining trip protection
It gives you medical insurance internationally, covers for many circumstances that may require you to cancel or have trip interruption. It can also cover pre exisiting conditions if purchased within 14 days of deposit. Would you like for us to sent you a quote after we have begun purchasing your trip?
Booking through us, adds social responsibility at no extra cost. When we receive a commission from our vendors, we donate a portion of our commissions to charity. We ask you to pick a charity to impact from our list. *
To learn more about our charities, visit https://www.bookheregivehere.com/charities
Payment Details
Please provide payment details below
Credit Card *

Card Number

Protected in vault Data collected via fields that have our security seal are encrypted and stored with the highest global security standard — PCI compliance. Your data is absolutely safe in Vault.
Signature *
Clear
Authorization of Charges
Terms & Conditions
Cancel policy for
Book Here, Give Here *
By completing this form and selecting this box, you agree and understand our Terms & Conditions
Client has been made aware that insurance/travel protection is not required but recommended. Not all credit cards cover you completely when you travel. Travel Agent is not responsible in the case of lost luggage, cancelled or missed flights or anything out of their control. Client is aware that travel protection may cover this and it has been offered. This is to confirm that, in keeping with all applicable laws, I am instructing Book Here, Give Here to issue airline tickets and any additional authorized travel against the credit card listed above. I further understand that I have authorized this transaction and will hold the above agency harmless with respect to these instructions. It is understood that above agency may request government issued photo identification and may verify the billing address of the card. This agency will only issue electronic documents for travel. The agency is not responsible for the issuance of travel identification such as passports and/or visas and travelers should insure they have or have been approved for the appropriate documents, before purchasing travel. Credit card Statement will have different merchants of record as we do our best to get you the best price possible. Our Professional Fees may be included. If they are not, you will receive a paypal link that is payable directly to us and is non refundable. Should you cancel your trip, a cancellation fee will be applied to the credit card on file. This fee can be up to 15% of the total cost of your trip. This is in addition to any cancellation fees any vendor may charge you. Receipt issued are the total charged by any vendor. Book Here, Give Here, LLC, is a registered Trademark. Complete terms and conditions can be found: https://www.bookheregivehere.com/termsofuse.html

Payment Details