Credit Card Processing Form

Please review and make a payment

Date:

Cardholder Name:

Phone #:

Card Type:

Card Number:

Exp. Date:

Billing Address

Street:

City:

State:

Zip:

Email:

Number of Passenger covered by this card:

Total amount to be billed to the above credit card:

Note: By requesting this authorization, I agree that I shall not decline, reject, or challenge such amount charged on my credit card for the purpose of paying for the various components of my trip for the passenger(s) identified in the reservation and on the Credit Card Holder's Authorization form which I agree to forward upon confirmation.

I also declare that I am aware that restrictions may apply to the services purchased and I am satisfied that such restrictions have been explained to me. I also am satisfied that I have been offered Trip Protection Insurance to protect me should I have to cancel this reservation for covered reasons and that I accept responsibility for obtaining any and all documentation required for the travel which I am purchasing.

I also understand that TeacherGroupTravel (TGT) and Adler Travel Network d/b/a/ SGS TRAVELSCOPE (SGS) do not own any of the equipment or facilities used on these travel arrangements and that TGT and SGS act only as agents for the operators and providers of related services.

Furthermore, I understand and agree that TGT, SGS, et al accept no responsibility for any injury, damage, loss, accident, delay, or irregularity that may occur in conjunction with the performance of these services

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