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 the Supplier who will be providing your travel services.
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
Name of Person(s) You Are Rooming With?
Name as it appears on your card
Middle Name or Initial if Applicable
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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