Travelcations Payment Authorization Form

Thank you for choosing Travelcations for your upcoming vacation. We look forward to helping you plan your vacation. For your convenience, you may use this form to transmit your credit card information to us. Completing this form does not process your payment - it simply authorizes our team to process a payment on your behalf.

First Name *

Last Name *

Phone Number *

Street Address *

Address Line 2

City *

State *

Zip Code *

Email Address *

Reason for Payment *

Agent Name *

Payment Amount *

Credit Card Type *

Name on Card *

Credit Card Number *

Expiration Date *

CVV code *

Is this a Debit Card? *

Yes

No

Comments/ Need to Know

Credit Card Authorization *

By checking the box, I hereby authorize Travelcations to charge my credit card for the amount shown above.