in Paris, LLC
10 Wildwood Trail
NEWTON, NJ 07860 USA
1 973 948 3535
Print this form & return it by mail to the address above or
fax to: 1 973 948 2232
CREDIT CARDHOLDER'S AUTHORIZATION
|In lieu of my credit card imprint, I __________________________________(print name of cardholder as shown on credit card)|
| hereby authorize Vacation In Paris, LLC to
charge credit card number ______________________________________
Security code (3 digits on back or for Amex 4 digits on front) _________.
|with an expiration date of ___ /___ (mm/yy) the amount of $_______________ (specify the amount for this charge in USD)|
|for payment of myself or _________________________________ (full name of traveler if other than cardholder)|
|for Vacation In Paris reservation number _________.|
|My credit card billing address is:|
|Street: _______________________________ Apt # ________|
|City ______________________, State/Province _________ Postal Code _____________|
|My phone number is: ________________________________|
|By signing below, I agree to the charges described hereon
and authorize Vacation In Paris, LLC, to process the above credit card for these charges
through the PayPal® system.
I agree to pay in full these charges in accordance
with the standard policy of company issuing the credit card. I
acknowledge that Vacation In Paris' terms, conditions,
policy, have either been provided to me in writing or explained to my satisfaction
by a representative of Vacation In Paris and I agree to those conditions. Under penalty of
US Federal laws and the laws of the State of New Jersey, I certify the foregoing is
true and correct.
After 60 days, refunds will be made either by check in US$ or to my PayPal® account.
Signature____________________________________ Date ______________________
Why is this form necessary?