CREDIT CARD AUTHORIZATION FORM

This is to confirm that, in keeping with all applicable laws, I, as a Credit Card holder authorize ExploreTrip Inc
to issue the tickets for the PNR/Routing mentioned below against the following Credit Card. I further represent
that I will indemnify and hold ExploreTrip Inc harmless with respect to these instructions.
PNR # / Routing

Charge Amount (in USD)

Name of the Passenger(s)

Credit Card Type:

VISA

MASTER

AMEX

DISCOVER

OTHER

Credit Card Number:

Exp date:

Cardholders name as it appears on the credit card:

Cardholders billing address & Credit Card company contact details:

Street :
City, State, Zip & Country :
Contact Phone :

Contact e-mail :

Credit Card Issuing Bank Name :

Credit Card Issuing Country :

Credit Card Company Phone number as listed in the back side of the card :
BY SIGNING BELOW, I ACKNOWLEDGE FULL LIABILITY FOR THE CHARGE DESCRIBED
HEREIN.

Cardholders Signature: ___________________________________

Date: ________________________

Note: Please send the copy of completed form to reservations@exploretrip.com or fax it to 1-866-527-2297