Credit Card Authorization Form

  • Credit Card Details

  • Cardholder Declaration & Authorization

  • I hereby declare under the penalty of perjury that the information provided above is true and correct. I hereby also state that I have read and agreed to the terms and conditions stipulated in the booking contract. By checking this box, I hereby authorize Platinum Travel Insiders, LLC to charge payments due for the contracted amounts to my credit card account. I likewise confirm that the payments herein charged to my credit card account are valid and accurate despite the absence of my signature in the sales slip or terminal receipt for such payments. I further waive the requirement that Platinum Travel Insiders, LLC issue, submit or deliver to me a true and completed copy of the sales slip or terminal receipt covering these payments. This authorization will be cancelled after 5 days from receipt by Platinum Travel Insiders, LLC of my written notice to cancel it. I have also attached a copy of the front and back of my credit card to be sent via fax or email.
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