Credit Card Authorization

The purpose of this credit card authorization form is to protect you, my valued client, as well as Shared Travel from credit card fraud. All information on this form will be kept strictly confidential. Please complete and sign this form and return to Shared Travel. This form MUST be completed and returned before any credit card payments for travel on your behalf will be made.

Credit Card Type *

Amount Approved *

Minimum Deposit

Final Payment

Other Other

First Name *

Last Name *

Credit Card Number *

Expiration Date (mm/yy) *

Billing Address *

Address Line 2

City *

State/Province/Region *

Zip/Postal Code *

Country *

Phone Number *

Email Address *

I understand that Shared Travel is not the source or supplier of the travel services I have requested, and acts solely as an agent for the actual suppliers of such services. I have been advised that the suppliers whose names appear in the information supplied to me are those who are actually responsible for providing the travel services I have purchased. I consent to and request the use of those suppliers and agree not to hold Shared Travel responsible should any of these suppliers: 1) fail to provide the travel services I have purchased; 2) fail to comply with any applicable law; or 3) engage in any negligent act of omission that causes me any sort of injury, damage, delay or other inconvenience. I accept that Shared Travel is not responsible for, nor will I attempt to hold it liable for any injury, damage or loss I may suffer for any conditions, actions or omissions that are beyond the reasonable control of Shared Travel. I will review my travel documents for accuracy upon receipt and understand that I may contact Shared Travel if I have any questions. I understand that discounted fares typically involve restrictions and that changing any aspect of my travel arrangements may result in the payment of additional money. I understand that if traveling internationally, I must have a valid passport and depending upon my destination and the origin of my passport, I may need to obtain a visa. Passport and visa information may be obtained by contacting the Travel Advisory Section of the U.S. State Department at (202) 647-5225 or by visiting the State Department’s Web site at www.state.gov. Non-U.S. passport holders should be sure to contact the embassies of their destination and transit countries to obtain entrance requirements. To obtain medical information, you may contact the Centers for Disease Control at (404) 332-4559 or visit the CDC’s Web site at www.cdc.gov. I understand that the airline tickets or air tours I am purchasing are subject to supplemental price increases that may be imposed after the date of purchase. Post-purchase price increases may be applied due to additional costs imposed by a supplier or increases government. I acknowledge that I may be charged additional sums by Shared Travel to offset increased fees, fuel surcharges, taxes, and fluctuations in foreign exchange markets or any combination thereof. I hereby consent to any post-purchase price increases and authorize Shared Travel to charge my credit card for such additional amounts. I understand that I may purchase travel insurance to cover certain risks inherent in travel such as supplier bankruptcy and the inability to travel due to a medical or personal emergency. I understand that I may obtain information on travel insurance from Shared Travel. *

I understand

Signature *

clear

Note: Your card will not automatically be charged by completing and submitting this form; however, completing and submitting this form does give the agent the right to charge the card for the amount and purpose authorized above.

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