Credit Card Authorization | The Boarding Lounge

“Please complete the form below to securely authorize payment for your travel arrangements with The Boarding Lounge.”

CREDIT CARD AUTHORIZATION FORM

TRAVEL ADVISOR INFORMATION

Name: Yomaris Matos

Phone Number: (407) 494-8196

Email: yomaris.matos@fora.travel

CARD HOLDER INFORMATION

Client's FIRST and LAST Name

Phone Number

Email Address

Cardholder's Name

Name as it appears on credit card

Card Type

Visa

Mastercard

American Express

Discover

Card Number

Expiration Date

Month

Day

Year

For the "DAY" put last day of the month.

CVV

3-digit security code on back of your card.

BILLING ADDRESS

Multi-line address

Country/Region

Address

City

Zip / Postal code

PAYMENT INFORMATION (Please select one below)

Payment in Full (Enter amount below)

One-time charge in the amount of:

Use this field only if you're making payment in full

Installment / multiple payments

The initial deposit and any future scheduled payments will be processed according to the payment schedule provided for your trip.

AUTHORIZATION TO CHARGE

I certify that I am the authorized cardholder for the credit card provided and authorize the applicable travel supplier(s), as merchant(s) of record, to charge my credit card for all travel arrangements and related services that I have approved for this trip and that are arranged on my behalf by Yomaris Matos of The Boarding Lounge, an independent travel advisor of Fora Travel, Inc.

I understand that authorized charges may be processed by one or more travel suppliers and may include deposits, scheduled payments, final payments, and other approved travel-related charges associated with my trip.

I understand that all charges are subject to the applicable supplier's terms and conditions, including cancellation, change, and refund policies.

Print Full Name

Electronic Signature

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Today's Date:

Month

Day

Year

Note: The purpose of this form is to give Yomaris Matos / The Boarding Lounge authorization to make a credit card transaction on behalf of the client, for a charge made by the supplier. For any questions about your booking, please email your travel advisor directly. The above payment is subject to the payment terms and conditions as stated on the trip itinerary or invoice.

Florida - Seller of Travel Registration No. TI125635