CREDIT CARD AUTHORIZATION FORM

           

Please complete in its entirety and return either by fax to 305-620-9033 or overnight mail to Academy Travel, Inc., 5190 N.W. 167th Street, Suite 103, Miami, Florida 33014.

 

This serves as my authorization for ACADEMY TRAVEL, INC. to charge the under mentioned credit card for the following reservation:

 

TODAY’S DATE: ____________________

 

Package requested:  Please check the appropriate box you select:

3 night package_____ / 4 night package_____ / Other____

Single: ____ / Double_____

 

PLEASE PRINT LEGIBLY IN BLOCK LETTERS THE NAME OF PASSENGERS TRAVELING:

1.  ___________________________________

 

2. ___________________________________

 

 

YOUR DEPARTURE CITY: ______________________

 

YOUR REQUESTED CHECKIN & CHECKOUT HOTEL DATE: _________________

 

YOUR AIRLINE RETURN DATE: ______________________________

 

YOUR ROOMMATE: __________________________________________________

 

YOUR CONTACT NUMBERS:

 

HOME: ______________________    WORK:_______________________

 

CELL: ______________________       FAX:___________________________

 

EMAIL: ____________________________________

 

*Acceptable credit cards are: MASTERCARD/VISA/AMERICAN EXPRESS.

 

Deposit: ___________/ Final Payment: _____________________

 

AMOUNT OF PAYMENT: ______________________CARD TYPE: __________

 

CREDIT CARD NBR: __________________________________ EXP.DATE: ____ SECURITY CODE:____________

 

Billing Address: ________________________________________________

 

City_____________    State____        Phone number: _______________

 

Cardholder’s Name:  _______________________________________________

 

CARDHOLDER’S SIGNATURE: ________________________________

 

DATE: ___________

 

ROOMMATE: _________________________________________

*Please provide a photo static copy of front and back of your credit card and driver’s license.

 

IS THE CARDHOLDER TRAVELING?  Yes     No

** If no, you must sign statement below***

 

I, __________________________________________, authorize ACADEMY TRAVEL, INC., to charge my credit card (card type)_____(number) _______________________________________(exp. date) _________ (security code)______ in the amount of $________________________for passenger _____________________________________to travel as stated above.

 

CARD HOLDER’S SIGNATURE_________________________________

 

DATE: ____________________________________

 

*Deposit and final payments are nonrefundable and nontransferable*

PLEASE, PLEASE MAKE SURE YOU ARE GOING*

*Prices subject to change without notice

*Travel insurance available at additional cost and strongly suggested.

*Final payment due 60 days prior to arrival.