Scheduled Payment Form

 
Hazleton, Pennsylvania
info@beaamazedtravel.com
(570) 599-1754
 
Please complete all required fields and click submit
All information will be held confidential

Cardholder Information

Traveler Information

Please list all travelers names and birth dates as they appear on their official identificiation (i.e. passport and/or drivers license)

Payment Schedule

Payment Authorization

Visa
I hereby authorize Bea Amazed Travel to automatically debit my redit card monthly in the amount authorized by me, on the date authorized by me, for the number of payments authorized by me. I understand and agree that as long as I provide a minimum of 48 hours written notice to Bea Amazed Travel, these payments can be stopped by me at any time for any reason. I also agree and understand that with the same 48-hour written notice, I can complete a new authorization to use a different credit card. I further agree that the same cancellation and refund policies apply to my monthly payments as originally described at the time of booking. 
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