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Credit Card Payment Authorization Form

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DIGITAL CREDIT CARD AUTHORIZATION FORM:

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:

CVV:

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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Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

Audit

March 11, 2020 12:32 pm MST

Credit Card Payment Authorization Form Uploaded by HE Travel Client Services - info@hetravel.com IP 75.169.158.36