Epic Travel Atlanta Payment form

Epic Travel Atlanta, LLC is an approved travel agency authorized to conduct business with all travel suppliers including, but not limited to airlines, car rental agencies, hotels, cruise lines, tour operators and travel insurance companies. You should complete this form if you are using your credit card to purchase travel services for yourself or other individuals known to you. Please fully complete and return this form to us using the fields provided below. The purpose of this Credit Card Authorization form is to comply with credit card acceptance rules with travel suppliers and to protect you the cardholder and your travel agent from credit card fraud. If you were not offered travel insurance at the time of your booking, please contact us if you are interested in purchasing it.

Name:	* Required
Email:	* Required
Trip and Travel Date:	* Required

Card Information:

Type of Card:
Name on Card:
Card Number:
Expiration Date:
Code on the back or front of card:
Amount:
Billing Address If different from mailing Address:
City, State, Zip:
Home Phone:

I certify that all information is complete and accurate. I hereby authorize Epic Travel Atlanta to collect payment for all charges as indicated above on this form by processing a charge to the credit card listed above. Charges must not exceed the amount listed above. I understand that a new form will have to be completed if another payment needs to be made. I certify that I am the authorized signer of the credit card.

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