Please sign and complete this form to authorize April Busby with The Curated Travel Collection to make a one-time debit to your credit card listed below.

By signing this form, you give us permission to debit your account for the amount indicated on or after the stated date. This is permission for a single transaction only and does not provide authorization for any additional unrelated debits or credits to your account.
 
Please complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until canceled.

Client Information

Payment Information

Visa
 +
Credit Card Authorization *
Future Transactions *
I hereby authorize The Curated Travel Collection to use the credit card indicated to make future payments on the following.
Terms and Conditions of The Curated Travel Collection, LLC *
Signature *
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