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CC Auth Form
CC Auth Form
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To complete your transaction and confirm your arrangements, your signature on this authorization is required. Charges are payable ONLY to Blessed To Travel, Blue City LLC, the hotel, resort, tour operator, cruise line or other travel supplier.
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Email
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Address
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*
Travel Insurance Waiver
For your protection, travel insurance is highly recommended, and insurance recommendations can be provided upon request from Blessed To Travel. If you choose to decline the recommended travel insurance, select the option below with your required signature.
Please select which statement applies and provide your signature:
*
My signature confirms that I have opted to accept the travel supplier’s travel insurance, and I am aware that the insurance is non-refundable. I have read and understand all terms and conditions provided by the agent and travel supplier regarding cancellation of the trip.
My signature confirms that I have accepted and authorize travel purchases and I have been given information about travel insurance. I am DECLINING the travel insurance offered and/or will seek out my own travel insurance. I have read and understand all terms and conditions provided by the agent and travel supplier and that I may not be entitled to a full refund should I cancel, or my travel plans change. In case of cancellation, applicable penalties may apply according to travel supplier’s terms, and I agree to pay penalties or fees applied.
Signature regarding Travel Insurance:
*
Clear Signature
Please Select Payment Type:
*
I authorize a payment for the initial deposit amount and any future balance to be paid until final balance has been paid in full by the due date
I authorize a one-time payment to pay the full amount
I authorize a one-time payment to pay the remaining balance only
Card Type:
*
VISA
Mastercard
Discover
AMEX
Credit Card Number:
*
Name on Card:
*
Card Expiration (i.e. MM/YYYY):
*
CVV:
*
Billing Address:
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Date
*
Signature regarding authorization of Credit Card Charge:
*
Clear Signature
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