Credit Card Authorization Form

* Indicates a required field
* Name (as on card)
* Card Type
* Account Number
* Expiration Date MM/YY
* CV V2
3-Digit Security Code Shown on the Back of your credit card
   
* Amount
   
Pay for travel arrangements for myself and additional travelers named here:
   
* Email Address
* Confirm Email Address
* Phone Number
* Billing Address
* City
* State / Province
* Zip / Postal Code
* Country (other than USA)
   
* Destination
* Departure Date
* Return Date
 
Group Leader Name
 
Prices quoted reflect a cash discount of 2.5% for payments made by personal check, company check, cashiers check or money order. Payments made by credit card result in a loss of the cash discount. I, hereby authorize WaterWays Travel to charge my credit card with account information listed above in the amount listed above plus an additional 2.5% due to loss of cash discount. I agree to pay this amount to my financial institution.