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Booking Details: |
1. PNR or Reference Code (see email confirmation): ___________________________
2. Departure Date: ___________________________________________________________
3. Airline + Routing: ________________________________________________________
4. Passenger Name(s): ________________________________________________________
___________________________________________________________________________
5. Telephone: ________________________________________________________________
6. Email Address: ____________________________________________________________
Payment and Credit Card Billing Details:
7. Grand Total Amount (see email confirmation): ______________________________
8. Card Number: __________________________________________ 9. Exp.Date: ______
10. Billing Address: __________________________________________________________
City _____________________________________ State: ________ Zip: ___________
11. Name on Card: _____________________________________________________________
12. Customer Service Number on back of card: 1-800- ___________________________
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| I certify I am the bank authorized signer/cardholder for the above account and agree to the charges described herein, which will be charged to my credit card by the agent who issues my ticket(s). I acknowledge that I am aware of the terms and conditions of the fare including non-refundable rules, changes are subject to fees, travel is not transferable, and other restrictions on the travel authorized, using my credit card as further described in the email flight confirmation I got for this booking. |
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| Signature Cardholder | Date | Place |