Credit Card Authorization Form

2400, Camino Ramon, Ste - 163, San Ramon CA 94583.

Tel (510) 790-4800 Fax (510) 790-0400

www.lowfaretravel.com

CREDIT CARD AUTHORIZATION FORM

Please return this completed form by mail or fax to +1 510 790 0400

All information and payment details authorized by the cardholder for payment(s) towards specified payment type below, will be kept strictly confidential. We shall respect Cardholder privacy and safeguard against identity theft. We will never rent or sell any information supplied on this form. Lowfaretravel are authorized to process any payments specified.

IMPORTANT:If the cardholder is not the traveler please submit with this formal eligible copy of the front and back of the card and eligible copy of a valid government issued identification document such as passport /driver’s license / state issued ID.

Passenger Details

Payment Information

Card Type

(For Visa/MasterCard, this is the last 3 digits on back of card on signature panel, after the Credit card number. For American Express, this is the 4 digits on front of card above the credit card number)

Amount Authorized

plus any cancellation penalties imposed or additional services provided by Lowfaretravel.

Billing and Contact Information

Credit Card Billing Address

Please Confirm full name and signature.

I agree to be legally bound by this agreement and eSignature