Credit Card Authorization Form - All Star Liveaboards printable pdf download

Credit Card Authorization Form - All Star Liveaboards

CREDIT CARD AUTHORIZATION FORM

This form must be filled out completely in order for us to process your request.

Visa _____ MasterCard _____ Discover _____

Account #___________ ____________ ____________ _____________

Expiration date: ______/________ Sec code (3 digits) _______________

Name as it appears on the card: ____________________________________________

I Authorize All Star Liveaboards to charge the amount of: _______________________

For my cruise aboard: AQUA CAT___

BLACKBEARD___ CAT PPALU___

Trip Date: __________________________________

_____I elect to preauthorize my final payment to be auto run on _____________date (60

days prior to departure) for the amount of __________________________________.

_____I do not authorize final payment to be auto run and will arrange payment by the due date.

Group name if applicable___________________________

Signature: _____________________________________________

E Mail Address: _________________________________________

Phone number: _________________________________________

Billing Address: _________________________________________________

_________________________________________________

Please scan or Fax this form to our US reservations office.

954.321.6582 FAX. For questions or concerns, 954.734.7111 or toll free 800.327.9600

Credit Card Authorization Form - All Star Liveaboards