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:
1-
2 -
3-
4-
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: