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Credit Card Authorization form for Aventina Travel and RubysTravel
Person completing this form. THIS MUST BE THE PERSON WHOSE CARD IS BEING CHARGED OR WE CANNOT PROCESS THE PAYMENT.
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This form is for you to authorize a charge for your travel booked with Aventina Travel and RubysTravel. Please briefly describe what this charge is for (travelers, type of trip, location, travel dates, insurance) If this is a deposit, please include the full legal names of the travelers EXACTLY as they will appear on their passports if traveling internationally.
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Amount you are authorizing to charge to the card.
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Are you authorizing any recurring payments or future payments. If so, please describe.
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Name on Card
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Company name, if applicable
Billing Address
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Address Line 2
City
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State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
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Phone Number
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Country
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Email Address
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Credit Card Type
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Visa
MasterCard
American Express
Discover
Credit Card Number
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Expiration Date (mm/yy)
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Security Code
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By signing here, I certify that the owner of the card identified on this form is authorized to pay the amount indicated above. I authoriize the payment of such amount (together with any other charges due thereon to Aventina or any tour operator, vendor, supplier, cruise line, etc. that Aventina uses to book my trip). And I agree to the terms and conditions of Aventina, RubysTravel and the vendor being paid. Agreed by authorized signer for the card by signing below:
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Please use this space to provide any additional information you would like us to know.