CC authform

	** Attention to Credit Card Holder **
	In order to process your order, you must fax completed form to our office along with a copy of your
	CREDIT CARD & Driver's LICENSE (back&front copies-please make copies enlarged and light
	No third party payments accepted without notarized card holder's consent!
	All flights must be reconfirmed 72 hours prior to departure
Credit Card Holder: After fill out this form, Please press submit button for print page.
Contact information in US	If billing address is different, please complete. (Check if same as contact information )

First Name
Last Name
Middle Initial
Street Address
Address (cont.)
City
State
Zip Code
Home Phone
Work Phone
Cell Phone
FAX
E-mail

Street Address
Address (cont.)
City
State
Zip Code
Country
Work Phone
Home Phone
FAX
E-mail
BILLING INFORMATION DEBIT CARDS NOT ACCEPTED
Card
Credit Card Number#
Exp Date
CID / CVC	Security Number
Total Charges $

Passenger Names

Ages

Travel Information:

Departure Date
Departure City
Arrival City
Return City
Return Date
Arrival Country

Hotel Name

Cruise Line

Car Rental company

Special service request

2
3
4
5
	Child: 2-11 Years old,
	Infant: 0-24 months old.
	Student: Valid student ID required
	Senior Citizen: Over 60 yrs
Yes	I understand that my tickets will be delivered with special mail delivery service and a $10.00 fee will be charged.
Yes	I have been advised that travel insurance is available for an additional cost and I DECLINE to purchase travel insurance.

* This form must be completed before being faxed. There will be no transaction for incomplete forms. * Third party credit card payments not accepted.

* To travel abroad, a valid passport is required and visas may be necessary. All documents should be prepared before travel documents are ordered. It is the passenger’s responsibility to obtain all required passports and visas.* A government-issued picture ID is required for all domestic flights. * Upon purchase, your itinerary will be available to you on the internet. Please check and make sure everything is in order. * Quoted fares are subject to change until ticketed or paid to the

supplier. * We are not responsible for lost or delayed regular mail delivery. Lost ticket transactions require a new ticket purchase. By signing below, I acknowledge the above charges and authorize the charging of my account as indicated above. I understand that airlines, hotels tour operators and cruise lines may, in their discretion, charge a penalty for any change or cancellation. In addition, Prime Travel Services, Inc. charges $85 per person for any changes to the itinerary. Prime Travel Services, Inc. or its agents acts only as agents for passengers in regard to travel arrangements and accepts no responsibilities for acts of suppliers or an act of god. I have read and understand the terms and conditions and completely agree them all. I accept all the charges.

Please fax this form along with ID copies to

Date:

Fax 201-825-4153 Ph. 201-825-1600