Credit Card Authorization
Travel Purchase Authorization For Non-Website Purchases

Thank you for your purchase. InteleTravel.com is pleased to confirm the following arrangements. To complete your transaction and confirm your arrangements, your electronic signature on this authorization is required. This form is NOT required for electronic purchases you complete yourself on our website, www.InteleTravel.com, or its affiliates. Charges are payable ONLY to InteleTravel.com or the hotel, resort, tour operator, cruise line or other travel supplier. Independent Travel Agents may not accept and process charges through any other account, or accept checks, cash or other forms of payment.
Email address *
Customer First and Last Name *
Your answer
Phone Number *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Please include your roommate's FIRST and LAST name *
Your answer
Roommate Date of Birth *
MM
/
DD
/
YYYY
Select your room type *
Required
(Check One) *
Required
Credit Card Number
Your answer
Expiration Date *
Your answer
Billing Address *
Your answer
Billing Zip Code *
Your answer
CVV *
Your answer
For the amount of $ *
Your answer
Do you currently have a US passport? *
Required
I authorize InteleTravel.com and/or the travel supplier to charge my credit card for travel purchase. *
Required
Please verify all responses including your credit card information (card numbers and billing zip code) and date of birth (including year) before submitting. Please allow 1-3 days for your payment to be processed. You will receive a confirmation email once completed. *
Required
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