UP AND AWAY TRAVEL

347 FIFTH AVENUE, SUITE 305, NEW YORK, NY 10016         Tel: 212-889-2345 / Fax: 212-889-2350

  

PNR / Booking Ref. Code:_____________

CREDIT CARD AUTHORIZATION FORM

 

In lieu of my credit card imprint, I  ______________________________________________

hereby authorize UP AND AWAY TRAVEL  to charge  my credit card.

 

Type :-    Amex   -   Visa   -   Master   -    Discover   (Circle the appropriate Credit Card)

 
Credit Card # _______________________________________ CCV Code#______
  

Expiry Date (mm/yy):____/____ in the amount of  US $__________ . ____  for the

 

transportation of my self and/or __________________________________________

 

_____________________________________________________________________
   
ISSUING BANK NAME & TELEPHONE: _______________________________________

  

Itinerary as follows:

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Telephone #: HOME:  __ __ __ __ __ __ __ __      WORK :  __ __ __ __ __ __ __ __

 
BILLING  ADDRESS

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NOTE: Identification is required. Please provide photostat copy of  the credit card and 

          passport or driver’s license of the cardholder. By signing below, I acknowledge  

          charges described hereon. Payment in full to be made when billed or in extended   

          payments in accordance with standard policy of the credit card company.

I AM AWARE THAT THIS TICKET IS VERY RESTRICTED AND MAY BE NON-REFUNDABLE. PENALTIES APPLY FOR ANY VOLUNTARY CHANGES OR CANCELLATION OF TICKETS.

                                                                                                                      

SIGNATURE  X   ___________________________

 

Incomplete information or false statements shall be considered sufficient cause for denial of ticket