Credit Card Authorization

Black Sea Travel nd

512 Ave U, 2 Floor Brooklyn, NY 11223

Tel: (718) 787-2070 Fax:(718) 787-2071

CREDIT CARD AUTHORIZATION FORM I, _______________________________________________________________________________ AUTHORIZE TO CHARGE MY CREDIT CARD IN THE AMOUNT OF _________________________

FOR (BRIEF TRIP DESCRIPTION)

TRAVEL DATES: ___________________

FLIGHT INFO: ____________________________________________________________________ DESTINATION ____________________________________________________________________

INSURANCE:

INCLUDED

CREDIT CARD: ( ) VISA

NOT INCLUDED

( ) MASTER CARD

( ) AMERICAN EXPRESS

( ) DISCOVER

CREDIT CARD NUMBER: __________________________________ ________________________ EXP. DATE:___________

SECURUTY CODE (3 or 4 digits from the back your card)__________

CARDHOLDER’S BILLING ADDRESS: _________________________________________________

CARDHOLDER’S TELEPHONE NUMBER: HOME__________________ BUS ________________ • •

• •

PLEASE PROVIDE A LIGHT COPY OF YOUR CREDIT CARD (BOTH SIDES) AND A COPY OF CARDHOLDER’S PICTURE ID OBTAINING VALID TRAVEL DOCUMENTS INCLUDING PASSPORTS, VISAS, VACCINATION CERTIFICATES IS THE SOLE RESPONSIBILITY OF THE PASSENGER. THESE DOCUMENTS MUST BE ALWAYS CARRIED DURING THE ENTIRE JURNEY CHECK IN AT THE AIRLINE COUNTER IS REQUIRED AT LEAST 2 (TWO) HOURS PRIOR TO FLIGHT TRAVEL AGENT(S) CARRY NO RESPONSIBILITY FOR PROBLEMS THAT ARE BEYOND AGENTS CONTROL

I HAVE READ AND AGREED WITH THE INFORMATION ABOVE. I HAVE ALSO BEEN INFORMED ABOUT RULES AND RESTRICTIONS REGARDING MY TICKETS, TOURS AND VACATION PACKAGES INCLUDING POSSIBLE PENALTIES FOR PASSENGER CHANGES AND / OR CANCELLATIONS SIGNATURE OF CARDHOLDER’S___________________________ DATE _______________