Credit Card Authorization - Brazilian Wave Tours - Credit Card Authorization Confirmation Page

ATTENTION:

This form can be sent to our office via email if you have a scanner Print this page | fill it out & sign it | scan it and email the file to our office. Thank you!

A MEMBER OF:

PLEASE READ PRINT & SIGN
FAX THE AUTHORIZATION FOR CREDIT CARD USE TO: (954) 568-1521
or scan this form & email: info@brazilianwavetours.com

Credit Card #		Exp. Date:	/ / 200

Issuing Bank:		Phone No:

Name:	(as it appears on Credit Card)

Billing

Address:

Home Phone:		Work Phone:

E-Mail:		Website:

Passenger (s)	1) 2)

	3) 4)

Authorized Charge	To My Credit Card In The Amount of US$

Confirmation Sign:

PLEASE READ CAREFULLY
I give full authorization to BRAZILIAN WAVE TOURS to charge the above mentioned amount on my credit card as identified above and I shall not decline, reject or challenge such amount charged to my credit card for the purpose of paying for air tickets / hotels / or any other services purchased for the benefit of the passengers identified above. I also declare that I am aware that some restrictions may apply to the tickets purchased within this transaction and I am satisfied that such restrictions have been explained to me in advance. For the land portion of the trip, every detail and description of the tours and hotels were given to me. In addition, the check-in at hotels are at 2:00 pm and the check-out at 12:00 noon. I understand that air tickets can't be re-routed and in the event of No-Show the result is a total void (LOSS) of the ticket. To complete my order it is important that I complete this form and email and fax a signed copy along with the Policy, Terms & Conditions, before Brazilian Wave can issue my travel confirmation papers. If I need any assistance in completing these steps, I must call Brazilian Wave right away. □ Yes, I acknowledge and I agree with the Policy, Terms & Conditions as per attached signed document. I do certify that my travel agent has advised me that I need a valid passport and a tourist visa and should contact the nearest consulate for the countries of destination. Card Holder's Signature _____________________________________________________________________________ Signed at (city) ____________________________________ State ______ Date _____/_____/200_____ NOTE: PLEASE ATTACH PHOTOCOPY OF BOTH SIDES OF THE CREDIT CARD & DRIVERS LICENSE OR PHOTO-ID. ALL DOCUMENTS MUST BE LEGIBLE FOR ACCEPTANCE NO EXCEPTIONS.