Credit Authorization Form

Elegant Adventures Travel

47001 Harbour Pointe Ct.

Belleville, MI 48111

Please mail the following items:

(1) THIS AUTHORIZATION FORM

(2) PHOTOCOPY OF CREDIT CARD (BOTH SIDES) and

(3) PHOTOCOPY OF DRIVER'S LICENSE OR PASSPORT

Fill in CREDIT CARD TYPE:

(  ) Visa     (  ) Master Card     (  ) American Express     (  ) Discover Card

Card Holder's Name: ____________________________________________

Credit Card Number: _____________________________________________(Print Clearly)

CVC Number: __________________________ (last 3-4 digits of number on back or card)

Expiration Date: ______/______

Bank Phone (see back of card): ________________________________________

Billing Address where you receive credit card statements:

___________________________________________________

___________________________________________________

Card Holder Phone: ____________________________________

E-mail address: _______________________________________

Cell Phone: __________________________________________

I, the card holder, _______________________________ have read and understand the terms and conditions of Elegant Adventures Travel and agree to them completely.

I authorize Elegant Adventures Travel or its affiliated ticketing agency to charge in full the amount of $____________ for travel related services for the following passenger:

_________________________________________________________________

Sign below that you agree to the conditions on this form.

CARD HOLDER SIGNATURE: _________________________________________

DATE: ____________________________________________

Shipping Address for paper tickets or e-ticket receipts, if mailed:

_________________________________________________________________

_________________________________________________________________