Royal Travel Payment Authorization

Card Type(Required)

Number(Required)

Expiration Date (MM/YY)(Required)

CCV(Required)

Amount authorized to charge at this time(Required)

In payment of:

Service Fee

Deposit

Final Payment

Other

If the above payment is a deposit, do you authorize Royal Travel & Tours to charge your party’s final payment when due to this credit card? I understand that if I select “No” it is my responsibility to provide method of final payment to my Royal Travel & Tours at least two (2) weeks prior to the final payment date as indicated on my confirmation.

Yes

I authorize future charges to this card by Royal Travel & Tours and/or the supplier of travel services as agreed with Royal Travel & Tours. I understand that if I select “No” I will be required to complete a Credit Card Authorization Form every time a payment is made with the card stated above.

Yes

Cardholder Information:

Name on Card(Required)

Address(Required)

Cell Phone(Required)

Email(Required)

Cardholder Digital Signature(Required)

Date(Required)

Select Advisor(Required)

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