Note: The credit card user shall bear the name of one of the passengers. Third party credit cards are not accepted.

Name of Passengers:

Credit Card Information:

Card Type:

Credit Card No.:

Exp. Date

Sec. Code

Card Holder Information:

Name

Phone

Billing Address

City

Province

Zip

Authorized charge amount in USD

plus any insurance

I give authorization to Sterling Travel Services, to charge in the aggregate, the above noted amount on my credit card as identified above and shall not decline, reject or challenge such amount charged on my credit card for the purpose of paying for the passengers identified above. I also declare that I am aware that restricitions (as outlined under the terms and conditions) apply to the travel reservations.

I AM purchasing cancellation insurance and out of country medical insurance

DECLINE to purchase cancellation insurance and out of country medical insurance. **Unless indicated insurance is deemed to be declined.

Cardholder must sign below. Please provide copy of drivers licence front and back. Please email back to mgreaves@sterlingtravelservices.com

Cardholder Signature

Date

Important: Fill out the entire form before you click the button to print, all fields are required. Print and Sign.

Jodi-Ann and Jonathan Wedding Group