AUTHORIZATION FORM to charge a CREDIT CARD

Important: Print or type all information as requested and provide a photostat copy of the credit card (front and back) and driver's license of the cardholder. Otherwise this form will not be accepted! To submit this form, print this window, fill it out and fax to Embassy Travel at (202) 429-9162.


Cardholder Name:



 Billing Address:



Cardholder Home Phone:



 Billing Work Phone:



Credit Card Number: VISA/MC/AMEX/DISC



 Expiratory Date:



Total Charge Amount:



 Cardholder Fax Number and/or Email Address:



Cardholder Signature:



 Date:



Names of all passengers traveling using this credit card:



I am a client of Embassy Travel Service of Washington, DC. I hereby authorize Embassy Travel and/or it's consolidators to charge my credit card for the airline ticket(s), tours, cruises and/or fees associated with this purchase. I agree to honor and abide by terms of payment and cancellation policy.  I further agree that I will pay for all such purchases and will not hold Embassy Travel  responsible for any of its actions pursuant to this authorization. If ticket is refunded, I authorize Embassy Travel to charge same credit card any fees associated with this transaction (shipping, visa service & penalty fees etc.)