Authorization Form

Please Fill Out our Credit Card Authorization Form

Please reach out if you have any questions

Name as it appears on card *

E-mail *

Billing Address

PLEASE CHECK WHICH APPLIES AND SIGN BELOW

I have ACCEPTED and authorized the travel purchases below, including travel insurance, and I am aware the insurance premium is not refundable. I am DECLINING TRAVEL INSURANCE and I have ACCEPTED and authorized the travel purchases below, and I understand that by checking here. I have read and understand all cancellation charges and change fees related to the above travel arrangements, and that I may not be entitled to a full refund should my travel plans change. In case of cancellation of nonrefundable airline tickets or other arrangements, I agree to pay all applicable penalties according to the travel supplier’s rules.

Digital Verification: Please type your name to represent an electronic signature *

Pay deposit amount below and balance to be paid in full by due date

Pay full amount due today

VISA

MASTER CARD

AMERICAN EXPRESS

DISCOVER CARD

Expiration Date

CVC Number

Authorized Amount to Charge *

Yes

I authorize Bess Travels to charge my credit card for the authorized amount. I understand that my information will be saved to file for future transactions on my account

Digital Verification: Please put your initials and birth date to represent an electronic signature

Yes

I authorize Bess Travels to charge my credit card for the authorized amount. I understand that my information will be saved to file for future transactions on my account