Credit Card Authorization

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Black Sea Travel

nd
512 Ave U, 2 Floor Tel: (718) 787-2070
Brooklyn, NY 11223 Fax:(718) 787-2071

CREDIT CARD AUTHORIZATION FORM


I, _______________________________________________________________________________

AUTHORIZE TO CHARGE MY CREDIT CARD IN THE AMOUNT OF _________________________

FOR (BRIEF TRIP DESCRIPTION) TRAVEL DATES: ___________________

FLIGHT INFO: ____________________________________________________________________

DESTINATION ____________________________________________________________________

INSURANCE: INCLUDED NOT INCLUDED

CREDIT CARD: ( ) VISA ( ) MASTER CARD ( ) AMERICAN EXPRESS ( ) DISCOVER

CREDIT CARD NUMBER: __________________________________ ________________________

EXP. DATE:___________ SECURUTY CODE (3 or 4 digits from the back your card)__________

CARDHOLDER’S BILLING ADDRESS: _________________________________________________

CARDHOLDER’S TELEPHONE NUMBER: HOME__________________ BUS ________________

• PLEASE PROVIDE A LIGHT COPY OF YOUR CREDIT CARD (BOTH SIDES) AND A COPY OF
CARDHOLDER’S PICTURE ID
• OBTAINING VALID TRAVEL DOCUMENTS INCLUDING PASSPORTS, VISAS, VACCINATION
CERTIFICATES IS THE SOLE RESPONSIBILITY OF THE PASSENGER. THESE DOCUMENTS MUST
BE ALWAYS CARRIED DURING THE ENTIRE JURNEY
• CHECK IN AT THE AIRLINE COUNTER IS REQUIRED AT LEAST 2 (TWO) HOURS PRIOR TO FLIGHT
• TRAVEL AGENT(S) CARRY NO RESPONSIBILITY FOR PROBLEMS THAT ARE BEYOND AGENTS
CONTROL

I HAVE READ AND AGREED WITH THE INFORMATION ABOVE. I HAVE ALSO BEEN
INFORMED ABOUT RULES AND RESTRICTIONS REGARDING MY TICKETS, TOURS
AND VACATION PACKAGES INCLUDING POSSIBLE PENALTIES FOR PASSENGER CHANGES
AND / OR CANCELLATIONS

SIGNATURE OF CARDHOLDER’S___________________________ DATE _______________

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