SAFEJURNEE TRAVEL

Tel:  301-754-2179/Fax: 301-754-1130

Email:  Safejurnee@yahoo.com /Mayfee@hotmail.com

 CREDIT CARD AUTHORIZATION FORM

In order to make a transaction using credit cards, we must receive an imprint of clients card on a UCC form or have this authorization form filled out.

Name of Passenger(s)

1.

2.                                    

3. 

4.                               

5.

6. 

Credit Card Holders Name:

Credit Card Number:                                           Exp. Date:

Card Type: (Check appropriate one)

Master Card { } Visa { } Discover { } American Express { } Other: { }

3 or 4 Digit Security Code

                                    (found on the back of your card)

Card Holders Signature:                                              Date:  

Billing Address:

By signing this I am fully responsible for any discrepancies or charge backs that may occur.  In case of any legal suit, I agree to pay the full amount indicated on this form and any legal fees associated with this transaction.

I                                                              have read and understood the terms and conditions of Safejurnee and agree to them completely.  I authorize Safejurnee/________ (affiliate) to charge the full amount of US$                               

(in words)(_______________________________________________________________)

Please fax this form to SAFEJURNEE Travel Office (301-754-1130) along with:

1.                   Clear Photocopy of both sides of Credit Card.

2.                   A clear photocopy of Card Holders Drivers License / Passport (where applicable).