payment verification UNIQUELY PARADISE Uniquely Paradise 469-799-9673 and janacollier.travel@gmail.com PAYMENT AUTHORIZATION FORM I hereby authorize to process the credit card information provided for the reservation details listed below: GUEST NAME TRIP TYPE: (CRUISE/PACKAGE/OTHER) SUPPLIER NAME CONFIRMATION DEPATURE DATE RETURN DATE NAME AS IT APPEARS ON CREDIT CARD LAST FOUR DIGITS OF CREDIT CARD **To protect your confidential information, do not provide full credit card number in this form. You will be contacted by your Travel Agent to provide your full credit card and CVV number. A copy of the driver's license is needed along with this form** TOTAL TO CHARGE TO MY CREDIT CARD EXPIRATION DATE BILLING ADDRESS CITY STATE ZIP DAYTIME PHONE NUMBER EMAIL ADDRESS CREDIT CARD HOLDER SIGNATURE DATE Countinue
