360 Pharr Road, Suite 632 | Atlanta, GA 30305

Phone: (404) 956-9138 | This email address is being protected from spambots. You need JavaScript enabled to view it. | www.cbevacations.com

CREDIT CARD CHARGE AUTHORIZATION FORM

CBE AGENT NAME:*

IN LIEU OF MY CREDIT CARD IMPRINT, I: (TYPE FULL NAME)*

HEREBY AUTHORIZE CHOCOLATE BROWN ENTERPRISES, LLC (CBE VACATIONS) OR IT'S SUPPLIERS OR THE TRANSPORTING AIRLINE, TO CHARGE $:*

CARD TYPE:*

ON MY CREDIT/DEBIT CARD #:*

EXPIRATION DATE:*

CCV#:*

FOR THE PAYMENT OF TRANSPORTATION OF MYSELF AND/OR: (PLEASE LIST EACH PARTY YOU AUTHORIZE TO BE CHARGED TO YOUR CC# FOR THE FOLLOWING ITINERARY)

MY BILLING ADDRESS IS:*

CITY:*

STATE:*

ZIPCODE:*

TELEPHONE (HOME/CELL):*

EMAIL ADDRESS:*

By signing below, I acknowledge charges described hereon, payment in full to be made when billed or in extended payments in accordance with standard policy of company issuing card. I am also aware of all restrictive conditions on the ticket that I am purchasing, (Non Refundable, Non Changeable/Changeable a fee, etc.), and other airline conditions for which CBE Vacations is not responsible. I recognize that the above amount may be different from the amount that appears on my tickets. Please note that all taxes & service charges are included in the above amount. I have read and agree to the CBE Vacations terms and conditions.

CARD HOLDER SIGNATURE:

DATE SIGNED:*

Your payment has been submitted. You will receive an invoice from your agent once the payment has been processed.

In order to protect yourself and our company against the fraudulent use of Credit and Debt Cards, thank you for completing and signing this form. (a photo copy of both the front and back of your card is required for transactions in which the cardholder is not the traveler). The personal information supplied by you will be treated in the strictest confidence and will only be used for this transaction.

Thank you for your business!

CREDIT CARD CHARGE AUTHORIZATION FORM

Couples