Cardholder Authorization Form

(If making an installment payment only
fill out the Cardholder Information section.)

X

Passenger Names

Insurance? YES NO
Insurance? YES NO
Insurance? YES NO
Insurance? YES NO

Cardholder Authorization

I have authorized Adventurous Excursions Travel to charge my credit card for the amount listed below for the following services (Which Trip):

I have been informed of the cancellation polices for our travel services and have been made aware of the benefits of travel protection. At this time I have decided to Accept travel insurance or Decline travel insurance.(Please Initial One)

Cardholder Information

VISA, MASTERCARD & DISCOVER credit cards have a three-digit (CVV) number. It is printed in the signature panel on the back of Visa, MasterCard and Discover cards. The verification number is the last 3 digits on the right side of the panel. AMERICAN EXPRESS credit cards have a 4 digit non-embossed number. It is printed above the account number on the front of your card. It may appear to the left or to the right, but it is always above your account number. DEBIT CARDS or if you card has no verification code, enter 0000 in the CVV/CID field.

Authorization:
I hereby authorize Shona Brantley dba Adventurous Excursions Travel to charge the indicated credit card listed above for the travel services stated above. I guarantee and warrant that I am the legal cardholder for this credit card. Contact Info. PO Box 842 Douglasville, GA 30133 770.366.2555