Please print this form, fill out and fax it to Verliz Travel & Tours (562) 924-0081.

Reservation Number _______________________

Letter of Authorization to Charge Credit Card

I Authorize Verliz Travel to charge the amount of $_________ to my credit card for travel services (Deposit $200.00 per person plus insurance).

I Authorize Verliz Travel to charge the final payment of $_________ to my credit card on ___________, 2003.

Credit Card Signature ____________________________________________________

Credit Card Number ________________________________ Exp. Date ____________

Is this a debit card? Yes ____ No ____

Please Print (Use Block Letters)

Name on Card ______________________________________________

Billing Address _____________________________________________

City ________________________ State ________ Zip _____________

Home Phone ___________________ Business Phone ______________

Fax Number ____________________ E-Mail _____________________

Resort Name __________________________ Travel Date ___________


Passengers legal names as it appears on their passport or birth certificate

1. ______________________________________
2. ______________________________________
3. ______________________________________
4. ______________________________________


Authorized By

Documents will be shipped by Airborne Express or regular mail. Airborne requires an adult signature to receive the travel documents.