Credit Debit card Authorization Form

"You have vacation dreams. We have dream vacations."

Name on Card *

Credit Card Number *

Credit Card Type *

3 digit code from back (Amex cards please provide the 4 digit code from front of card.) *

Expiration Date (mm/yy) *

Amount to be charged *

Billing Address *

Address 2

City *

State *

Zip code *

Email address *

Phone *

Notes

In lieu of a credit card imprint, I hereby verify I am the cardholder named above and authorize All Seasons Vacations LLC (and/or their affiliates) to charge the above credit/debit for my travel reservation. You are further advised that the posted charge may appear on your statement in the name of All Seasons Vacations LLC or one of our affiliates. You may request from All Seasons Vacations LLC the name of the affiliate that will appear on your statement. I have read, understand and agree with the AGENCY TERMS AND CONDITIONS and also the suppliers terms and conditions provided to me with my invoice. I understand my reservations will not be processed until this is completed authorization is received, and if not received with in all applicable deadlines my booking may be automatically canceled. I understand and agree with the cancellation penalties associated with this reservation. By submitting this payment, I agree to pay the total amount as entered above in accordance with the card issuer agreement. The cardholder understands and agrees to these terms and expressly waives the rights to credit card chargebacks as a means to mediate disputes. *

To complete the authorization to charge your credit card you must sign your name in the blank below. This will serve as your electronic signature- the equivalent to signing your name on a printed credit card authorization form. By signing this form you acknowledge you are consenting to do business electronically with All Seasons Vacations LLC and our tour operator partners. CARDHOLDER SIGNATURE *

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