CREDIT CARD AUTHORIZATION FORM – CUSTOMIZED

Cardholder Name (as shown on card):

First

Middle

Last

— Cardholder Details —

Email

Phone Number Associated with Card

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

— Card Details —

Card Type

Mastercard
VISA
Discover
AMEX

Card Number:

3 Digit Code (use the 4 digit code for AMEX):

Exp Date:

For domestic flights, all U.S. travelers must have a REAL ID compliant driver’s license (STAR ID in Alabama) or a valid US Passport.

If you need to update your driver’s license in the state of Alabama, here’s a list of the required documents you’ll need:
STAR ID REQUIREMENTS

For other states CLICK HERE

GUEST(s) INFORMATION

Complete this Section for each GUEST on Reservation.
* Click +ADD button at the bottom to add A guest.

(Don’t click submit until you’ve added all guests.)

GUEST FULL NAME (as it appears on the ID you will use for your flights):

First

Middle

Last

PLEASE LIST NAME “EXACTLY” AS IT APPEARS ON YOUR DRIVER’S LICENSE OR PASSPORT (whichever you plan to use to check in for your flight).

Cell Phone

List phone you will have with you during the trip.

Email

Home Address

Same as Billing Address Above

Home Address (if different than billing address)- skip if it's the same

Address Line 1

Address Line 2

City

State

Zip Code

Birthdate

Identification that will be used for flights:

Valid U.S. Driver’s License (Real ID compliant)
Valid U.S. Passport
Other

If you selected other above, list identification details:

If you have TSA PreCheck®or Global Entry, list your Known Traveler Number (KTN):

Note: the KTN is the “CBP PASSID” for GLOBAL ENTRY

Complete If you selected U.S. passport Above (if not, skip)

Verify name above is listed as it appears (in same boxes/fields) as your passport.

Passport Number (if you selected Passport above):

* A passport is required to travel internationally. You may also choose to use your passport to fly domestically vs. your driver’s license.

Date Passport Issued:

Passport Expiration Date:

LOYALTY ACCOUNTS

If you have loyalty accounts to apply to your air or hotel, list them below. (examples: Marriott Bonvoy, Hilton Honors, World of Hyatt, IHG One Rewards, Wyndham Rewards, Choice Privileges, Delta Sky Miles, American AAdvantage, Southwest Rapid Rewards, United Mileage Plus,

AIRLINE LOYALTY ACCOUNT NUMBER: (list airline and number)

HOTEL LOYALTY ACCOUNT NUMBER: (list hotel chain and number)

To Add the next guest, click the +ADD button below.

________________________________

AUTHORIZATION to Charge Credit Card

I authorize ANDERSON TRAVEL AND TOURS for the designated TRAVEL SUPPLIERS selected below to charge my credit card above for agreed upon purchases.

HOTEL+AIR PACKAGE – (Travel Supplier: ExpediaTAAP)
Included in Package above: HOTEL – Embassy Suites Portland Downtown
Included in Package above: ROUNDTRIP AIRFARE -Main Cabin Seats (Montgomery-Portland)
TRAVEL INSURANCE – (Travel Supplier: Squaremouth: Travel Insured International Plan)

Total Amount to Charge Credit Card Listed Above:

$0.00

Date to Charge Credit Card Listed Above:

I understand and agree on the total package price, destination, itinerary/details and terms/conditions as explained to me by ANDERSON TRAVEL AND TOURS. I understand and agree that ANDERSON TRAVEL AND TOURS is not responsible for any changes, errors, omissions, negligence or refund amounts/delays made by the designated TRAVEL SUPPLIERS.

Yes, I understand and agree.

I understand and agree that it is my responsibility to have the proper identification documents for my trip. I understand that any name changes or other changes to the itinerary will result in a fee from the TRAVEL SUPPLIERS. I understand that if my name and other guest names listed on my reservation do not match IDs, I may be denied boarding by TSA. I understand and agree that ANDERSON TRAVEL AND TOURS is not responsible for any travel disruptions, inconvenience or fees associated with identification issues and/or fees associated with changes made with a TRAVEL SUPPLIER.

Yes, I understand and agree.

I understand that ANDERSON TRAVEL AND TOURS charges a $50 cancellation fee if a booking is cancelled after final payment to cover our time and resources spent on your booking. This fee is payable by check or cash only. (no credit cards for cancellation fees)

Yes, I understand and agree.

I understand and agree that I am fully responsible for any charge-back dispute and/or non-payment to Credit Card Company or Issuing Financial Institution.

Yes, I understand and agree.

I understand that ANDERSON TRAVEL AND TOURS is not responsible for disputes between me and my credit card company/issuing financial institution regarding charges accrued directly with any TRAVEL SUPPLIER.

Yes, I understand and agree.

I understand that ANDERSON TRAVEL AND TOURS is not responsible for filing travel insurance claims or handling disputes between me and a travel insurance SUPPLIER. All insurance claims must be made directly with the TRAVEL SUPPLIER.

Yes, I understand and agree.

Electronic Signature Agreement:

I agree and understand that by typing my name below as an electronic signature, it is the legal equivalent of my manual signature and binds me to this agreement.

Date

Electronic Signature – Name

First

Middle

Last

— Cardholder Details —

— Card Details —

For domestic flights, all U.S. travelers must have a REAL ID compliant driver’s license (STAR ID in Alabama) or a valid US Passport.

GUEST(s) INFORMATION

Complete this Section for each GUEST on Reservation. * Click +ADD button at the bottom to add A guest.

Complete If you selected U.S. passport Above (if not, skip)

To Add the next guest, click the +ADD button below.

________________________________

AUTHORIZATION to Charge Credit Card

Complete this Section for each GUEST on Reservation.
* Click +ADD button at the bottom to add A guest.