Elite Travel Adventures              Payment Authorization Form

Please fill out this form to authorize Elite Travel Adventures to manually submit your payment for your travel. Please complete all required fields. This authorization will remain in effect unless cancelled. Please note payments are ONLY authorized during business hours. 

Sign in to Google to save your progress. Learn more
Email *
Traveler Name(s): *
Date of Birth of traveler(s) *
Delta Skymiles  #
Seat Preference *
Seat Preference of 2nd traveler
Clear selection
Booking Number: *
Enter "Deposit" if 1st payment.
Phone Number: *
E-mail: *
Date: *
MM
/
DD
/
YYYY
Payment Amount: *
Credit Card Type: *
Credit Card Number: *
Expiration Date: *
Input 01 if you do not have an expiration day.
MM
/
DD
/
YYYY
CVV: *
Billing Address: *
Sign & Date Below to Authorize Payment: *

I, the above named authorized card user, give Elite Travel Adventures authorization to charge the card on file for the purposes detailed above. I understand that this form's a legal binding contract and that by signing my signature to this form, I will be held accountable for all agreed upon charges above. This charge will be manually applied by Elite Travel Adventures to your reservation and a receipt will be sent upon payment. Please note, you will not see a charge on your account by Elite Travel Adventures, but you will see a charge from the supplier directly. Payments may take 3-5 business days to fully process and be reflected on your account

Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms