Credit Card Authorization Form

If you are using a credit card to purchase travel,

please complete, sign and return this form.

(subject to FL Statute 709.08)

Date ___/___/___

Cardholder Name (name as it appears on the card)

______________________________________________________________

Billing Address _________________________________________________

City ____________________________State ___________ Zip ___________

Ph (H) ________________ Ph (W) ______________ Fax _______________

Name of Traveler if other than Cardholder

____________________________________________________________

Credit Card Type (circle one): VISA---MASTERCARD---AMER. EXP.---OTHER ______________________

Credit Card Number _________________________________ Exp. Date __________

Description of Travel Being Purchased ______________________________________________________

_____________________________________________________________________________________

Amount: $_______________

Notes: __________________________________________________________________

I am a client of BIG Travel, hereby known as the Travel Agency. I authorize the Travel Agency to charge these purchases, as indicated above, to my credit card. Furthermore, I authorize the Travel Agency to sign any travel supplier credit card authorizations on my behalf, and intend such signature to bind me the same as if I had personally signed, and charge those purchases to my credit card account. I agree that I will pay for such purchases and will not hold the Travel Agency responsible for any of its actions pursuant to this Credit Card Authorization Form.

Please print your name and sign below. Please have your signature witnessed by one (1) person other than yourself.

_______________________________________________________
(Printed Name of Cardholder)

______________________________________________________
(Signature of Cardholder)

_______________________________________________________
(Printed Name of witness)

______________________________________________________
(Signature of witness)

NOTICE: This Form Must Be Signed & Returned To Our Offices Prior To Any Travel Documents Being Released!

Please Mail the form to:
Bart Gursky
BIG Travel
2410 Orchard Drive
Apopka, FL 32712

Fax: 407-880-2332