Latin Destinations: Credit Card Form

Latin Destinations Credit Card Authorization Form

Passenger must SIGN this form in order for the charge to be processed. Latin Destinations issues documents approximately 7 business days after receipt of final payment and ship by FEDEX to your shipping address.

1 - PRINT this Credit Card Authorization Form

2 - COMPLETE and SIGN the printed form

3 - FAX it with a copy of your photo ID to Latin Destinations at 202-785-0340

I have read and understood the Terms and Conditions as listed on the web site. I agree to adhere to them by signing below. Third party payments must include copies of credit card's front and back. Plus ID of the credit card holder.

Booking Number:

Departing Date: (mm/dd/yy)

All Passengers Names as they Appear on Passports:

2 -

Card Holder Name:

Please be advised that your credit card is subject to be charged in parts for the amount authorized below.

Card Holder Billing Address:

Address:
City:	State:	Zip:
Card holder's home phone number:

Credit Card: (Check one)

American Express

Discover

Visa

Master Card

Credit Card Number:

Credit Card Expires: (mm/yy)

Contact Information:

Day Time Ph:	Cellular Ph:
Night Time Ph:	E-mail:

Amount to Charge:

$	for Booking#(s)

If we cannot confirm services as per quote, we will send you a new invoice/confirmation form. If the final amount changes we will require a NEW credit card form with the adjusted amount.

Card Holders Signature:

Date(mm/dd/yy):

Travel Insurance:

I have been advised of and chosen to

ACCEPT or

DECLINE

Travel Insurance.

Shipping Address:
Documentation is sent by FEDEX requiring a signature upon receipt. We do not ship to PO BOX addresses.

Company or Name:
Attention/ Care of:
Address:
City:	State:	Zip: