Please sign and complete this form to authorize TMC Premier Travel 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 indicated 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.

Please note: We highly recommend using a CREDIT CARD. If using a DEBIT CARD, please contact your bank to pre-authorize the charge if over $1,000.00. Delays that occur due to the use of a debit card are the responsibility of the card holder.

Client Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Payment Information

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

CVV Code (3 digit number on back of card) *

Amount to be charged *

Date of payment * +

Purpose of Charge (i.e. Deposit, Final Payment, etc) *

Name of my TMC Premier Travel Advisor *

Credit Card Authorization *

I authorize the above-named agent with TMC Premier Travel to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form.

Please sign and complete this form to authorize TMC Premier Travel 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 indicated date. This is permission for a single transaction only and does not provide authorization for any additional unrelated debits or credits to your account. *

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