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~Payment Authorization Form
2023-03-20T19:18:33-05:00
PRIMARY TRAVELER
Title
Mr.
Mrs.
Miss
Dr.
First Name*
Last Name*
AMOUNT TO CHARGE
Charge Amount ($)
I authorize Tropical Dreams Travel or travel agent to use the information provided on this form to charge my credit card in the stated payment amount.
CREDIT CARD AUTHORIZATION FORM
BILLING INFORMATION
First Name*
Last Name*
Card Type*
MasterCard
Visa
Card Number*
Month*
Year*
CVV*
BILLING ADDRESS
Street Address
City
Province
MB
BC
AB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Postal Code
Email*
Date & Signature*
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