e4 Travel - Credit Card Authorization Form
IMPORTANT - Please note: Complete and accurate information is required to process this transaction. All information must be correct. 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!
Agent Name: Regina Dunbar Hendrickson
e4 Travel and Events Authorization - Card Usage
I have accepted the quote given to me by e4 TRAVEL & EVENTS and authorize e4 TRAVEL & EVENTS to use 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 payment may be made directly to selected travel suppliers on my behalf by e4 TRAVEL & EVENTS; 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 below signed for and acknowledged charges without proper course of action. I understand that e4 TRAVEL & EVENTS will impose the following charges when contractually applicable: all non-insured reservations are subject to Cancellation Fees of $35 per traveler will be applied to the provided credit card account. e4 TRAVEL & EVENTS will not release personal information to ANY parties not listed on you finalized Travel Quote and will apply due diligence in maintaining records in a secure, safe location.
I Agree to the Above Stated Terms
Terms and Conditions
I have received, reviewed and agree to the Travel Vendor/Supplier/Operator "Terms and Conditions" for the purchase of this travel service/vacation package.
* "Terms and Conditions were included with your travel service/vacation quote.
Client's Full Name
Client/Card Holder's Email
Full Name - as it appears on credit card to be used in this transaction:
Client/Credit Card Billing Address - make sure the address is correct - transaction will fail if the address is not the same as the billing address.
Address Line 2
State / Province / Region
Postal / Zip Code
Type of Credit Card to be Used in this Transaction
Credit Card Number
Please type your credit card number in exactly as on your credit card. Failure to do so may result in e4 Travel and Events being unable to obtain your booking and loss of quoted price.
Credit Card Security Code - 3 Digit Code on back of card **American Express - 4 Digit Code
Amount to be charged
Any Comments regarding the dollar amount to be charged in this transaction:
Select a Choice
Paid in Full at Booking
I 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 and checking the “I agree” box. I understand that my electronic signatures 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.
Please note payments marked as "Paid in Full" and/or "Final Payment" will not be processed UNLESS the CORRECT amount of full cost of the vacation/travel chargers will be paid in full and/or final payment does result in a zero balance on the account. Please call me to confirm your payment(s) if you have not already received this information from me. 618-667-1362 or 618-520-1144.
I understand that federal law forbids the carriage of certain hazardous materials, such as aerosols, fireworks, and flammable liquids, aboard the aircraft.
* If you do not understand these restrictions, contact your airline or go to
I hereby authorize e4 Travel and Events to retain this credit cared payment information on their secured server for the purpose and future payments on this reservation and/or future travel arrangements requested for my personal travel.