In lieu of my credit card imprint, I hereby authorize Flying Dutchmen Travel to charge my credit card number: Expiration Date: in the amount of US$, for payment of transportation for myself and/or the following passengers: for the follwing itinerary:

My billing address is:
Address:
Suite/Apt
City:
State:
Zip:
Daytime Phone
Fax:
Your Email:

By printing my name below, I acknowledge charges described hereon, payment in full to be made when billed or in extended payments accordance with the standard policy of the company issuing the credit card.
Print name here:
My mailing address is:
Same as Above:
Address:
Suite/Apt
   
City:
State:
Zip:
Daytime Phone
Fax:
We must receive a copy of your valid driver's license or photo ID accompanied by the front and back copy of your credit card for this to be considered a valid authorization form. Thank you!

 

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For assistance with this and other vacation offers
contact Tracy, Chris or Ann, our
Certified Specialists
800-514-5194

 
 

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