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  • e4 Travel - Credit Card Authorization Form

    Complete and accurate information is required to process this transaction. If we are not able to process a payment because of incorrect information, loss of your vacation pricing and/or cancellation of an existing reservation may result.

    Please double check your information for both of us. We want you to enjoy your vacation!
  • - -
  • $ .
  • As it appears on debit/credit card
  • Must match billing address for the card provided, or may be declined.
  • Authorization
    I authorize e4 Travel & Events to use the credit card information herein to pay for services, goods, accommodations, and other expenses I have been quoted and I accepted. I authorize e4 Travel & Events to make payment(s) directly to quoted travel suppliers on my behalf.

    Authorized Users
    By providing card information herein, you affirm that either you are the cardholder or that you are an authorized user for said card.

    I have reviewed the details of the travel invoice(s)/quote(s) as provided to me by e4 Travel & Events, and confirm their accuracy.

    These details include, but are not limited to:
    *The spelling of first and last names for all travelers
    *Travel dates
    *Flight dates, times, layovers, and seat assignments (if applicable)
    *Luggage allowances, requirements, restrictions and costs
    *Hotel/resort/cruise and stated room category
    *Ground transportation/transfers
    *Rental car class and authorized driver(s)
    *Excursions/Admission Tickets
    *Required local taxes and resort/tourism fees
    *No-show and cancellation policies
    *Vendor travel protection plan (if opting out of 3rd party insurance)

    Daily Charge Limits

    I understand debit/credit cards may impose "daily charge limits," thus multiple payments may be required to pay the full balance due. If necessary, I will contact my financial institution to ensure payment(s) can be processed and completed in a timely manner. I will notify e4 Travel & Events when payment(s) can be processed.

    Vendor Policies
    I am aware of any and all cancellation, change, refund and surcharge fees and policies of supplier(s). I agree not to dispute or chargeback any of the charges without proper cause of action.

    e4 Travel & Events will never release personal or financial information to parties not listed on your finalized travel quote. e4 Travel & Events will perform due diligence to maintain records in a secure, safe manner.
  • * Terms and Conditions were included with your travel service/vacation quote.

  • * If you do not understand these restrictions, contact your airline or go to
  • You agree your electronic signature is the legal equivalent of your manual signature on this agreement. By selecting "I Accept" you consent to be legally bound by this agreement's terms and conditions.
  • In order to process your payment request, we will need your CVV from the back of your credit card to complete your payment.

    Please call or text e4 Travel and Events with your CVV number once you complete this form.

    Due to compliance reasons, we can no longer collect this information. Please allow us 24-72 hours to process your payment as noted on your Payment Authorization Form

    Thank you for choosing e4 Travel and Events for your travel needs.


    Regina Dunbar Hendrickson
    Certified Travel Associate
    e4 Travel and Events
    542 Edwardsville Road
    Troy, Illinois 62294
    618-944-8117 - Office
    618-520-1144 - Cell

Agent Name: Regina Dunbar Hendrickson
Agent ID#20027808