4viajes.com

CREDIT AUTHORIZATION
For 4viajes or its Ticket Processor

7035A SW 47 St. Suite 200,Miami, Fl 33155
(877) 484-2537 for Reservations

Fax to the number you were given.
Or FAX Main Office (305)740-6915

Unless instructed differently, please fax the following items :
(1) This Authorization Form
(2) Photocopy of Credit Card (Both Sides) and
(3) Photocopy of Driver's License, Passport, or Utility Bill Statement

Please include your six-digit reference code:________________

Fill in CREDIT CARD TYPE
( ) Visa ( ) MasterCard ( ) American Express ( ) Discover Card

Card Holder's Name: ____________________________
Credit Card Number: _________________________ (Print Clearly)
CVC Number: _________________ (last 3-4 digits of number on back of card)
Expiration Date: _____/_____
Bank phone (see back of card):___________________
Billing address where you receive credit card statements:
_______________________________________________
_______________________________________________
Card Holder Phone: _____________________________
Card Holder Work Phone: ________________________ Cell_____________________

I, the card holder, ____________________________ have read and understand the terms
and conditions of 4viajes and agree to them completely (click here to review: Terms ).
I authorize 4viajes or its affiliated ticketing agency to charge in full the amount
of $______________________ for travel related service for the following passenger(s):
____________________________________________________
____________________________________________________
(include self in list if applicable)

Sign below that you agree to the conditions on this form.

CARD HOLDER SIGNATURE: ____________________________ DATE:_________________________
Shipping Address for paper tickets (if relevant):
_________________________________________________________

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