Perfect Reflections Travel, LLC
Debit/Credit Card Authorization
Book an Individual Trip
Book A Trip
Hotels & Accommodations
Debit/Credit Card Authorization: By submitting this form, you authorize Perfect Reflections Travel, LLC to debit/charge your card for travel services and you agree to the terms and conditions of Perfect Reflections Travel, LLC and
the Supplier who will be providing your travel services. Travel insurance is available for an additional fee and is highly recommended. Note that all payments are non-refundable unless you have travel insurance.
Payment for Travel Services
I Authorize my Debit/Credit Card to be Charged.
I, the debit/credit card holder, authorize Perfect Reflections Travel, LLC to debit/charge my debit/credit card for my travel services. By checking this box and submitting this form, I agree to the terms and conditions of the Supplier who will be providing my travel services.
PRT Agent/Referral Source
Indicates required field
Payment for which Individual or Group Trip?
Dates of Travel
Person(s) You Are Rooming With?
Name as it appears on your card
Names as appear on passports
Credit/Debit Card Type
Card CV2 # (3 digits on back of Visa, MC or 4 digits on front of Amex)
Billing Address (If your Mailing Address is Different, please provide it in the Comment Section)
Amount Authorized/Payment Plan/Comment
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