Credit Card Payment Authorization Form

--Please fill in all requested information. Data will not be saved until signed.--


Thank you for booking your trip with HE Travel. If you are paying by credit card, we must have your signature, billing address and phone numbers on file. I, the undersigned, give HE Travel the authority to charge my credit card ONLY for the vacation components we have discussed and I have agreed to. I understand that my credit card statement will read Hanns Ebensten Travel, Inc. or the names of partner suppliers. For airline tickets issued by HE Travel the credit card statement will read Uniglobe USA or the name of the airline.

Tour Name:

Name on Credit Card:

Amount Authorized to Charge:

Card Number:

Card Expiration:


Billing Address:

City, State/Province:

Zip/Postal Code:

Mobile phone number:  

Email address:  

Additional Notes:

Note: Under no circumstances will HE Travel make any charges to your card without your knowledge and express permission. This form is solely for the purpose of having your signature on file. In some cases a supplier has a format of their own for this signature and you may be asked to sign theirs as well as ours.

I have read and understand the Terms and Conditions 


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Signature Certificate
Document name: Credit Card Payment Authorization Form
lock iconUnique Document ID: 58dd7cda3c7852ca5540071a95255c3caa33d471
Timestamp Audit
March 11, 2020 12:32 pm MDTCredit Card Payment Authorization Form Uploaded by HE Travel Client Services - IP