CREDIT CARD AUTHORIZATION FORM

CREDIT CARD AUTHORIZATION

FIRST NAME*
LAST NAME
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
ACCOUNT NUMBER EXPIRATION DATE MM/YY CV V2 Cardholder Name
AMOUNT*
PAY FOR TRAVEL ARRANGEMENTS FOR MYSELF AND ADDITIONAL TRAVELERS NAMED HERE:*
Billing Information
Information as it appears on your billing statement
Email*
Enter Email Confirm Email
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Trip Information
DESTINATION*
DEPARTURE DATE (MM/DD/YYYY)*
MM slash DD slash YYYY
RETURN DATE (MM/DD/YYYY)*
MM slash DD slash YYYY
GROUP LEADER NAME*
TERMS*
- Prices quoted reflect a cash discount of 3% for payments made by personal check, company check, cashiers check or money order. Payments made by credit card result in a loss of the cash discount. I, hereby authorize Beau Proprietary Pte Ltd. to charge my credit card with account information listed above in the amount listed above plus an additional 3% due to loss of cash discount. I agree to pay this amount to my financial institution.