Agent Login/Registration

Credit Card Authorization Form

Personal Information

(*) Full Name:

(*) Address:

(*) City:

(*) State:

(*) Zip Code:

Card Information

(*) Card #:

(*) Expiration Date:

(*) CCV:

THE CVV IS THE LAST3 DIGITS ON THE BACK OF A MASTERCARD, VISA, AND DISCOVER CARD OR THE UPPER 4 DIGITS ON THE FRONT OF THE AMERICAN EXPRESS CARD.

Pricing Information

(*) Amount Due:

(*) 5% Handling Fee:

(*) Total:

Authorization Agreement

I, the undersigned authorize Continent Tours US Representative- Palace Travel, Inc. to charge my credit card for the total.

Authorization form must be completed, signed and received by Continent Tours no later than final payment date. Continent Tours will not be responsible for any consequences due to errors as a result of misspelled names. Any action or inaction taken by an airline or other transportation company is the sole responsibility of the guest.

A signed Authorization form is an acceptance of the rate confirmed, and constitutes acceptance of the Terms & Conditions.

I have read and understand the Terms & Conditions:

Electronic Signature:

Date:

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