CREDIT CARD PAYMENT FORM

I, _____________________________________, hereby authorize R Francis Travel Pro to charge the

amount specified below to my credit card.  I have reviewed and understand the refund and cancellation

policies described below.  ALL INFORMATION WILL REMAIN STRICTLY CONFIDENTIAL.

 

Lead Passenger Name: ______________________   Confirmation #: _______________________

 

CREDIT CARD:  _____Visa   _____MasterCard   _____Discover   _____Diner's   _____American Express

 

                                                                               _____Sign & Travel/Extended Payment Information

Information:

 

CREDIT CARD NUMBER: ______________________________________  Expires: __________________

 

*Very Important:  Include the three (3) or four (4) digit code on credit card ___________________

 

CREDIT CARD NAME:  ___________________________________________________________________

                                                                (Exactly as Imprinted on Credit Card)

 

CREDIT HOLDER'S ADDRESS: (Required for Processing)

 

Street: __________________________  City: ____________________  State: _____    Zip: __________

 

Home Phone: ___________________________  Business Phone: _______________________________

 

Cell Phone: ____________________________________   Fax: __________________________________

 

E-mail Address: ________________________________________________________________________

 

Authorized Sale Amount $__________  Authorized Deposit Amount $__________  Insurance __Yes  __No

 

Cardholder's Signature: __________________________________________  Date: _____________________

 

REVISIONS (except for simple addition of services): Minimum deposit payable at the time of booking

plus the costs of trip cancellation/interruption insurance (optional).  Balance due 45 days prior to

travel.  Many services are non-refundable once paid and/or documents have been processed if not

covered by trip cancellation/interruption insurance.  Costs and reasons vary according to policy.  See

your travel consultant for further details.

CANCELLATIONS:  $100 per booking once under deposit and $250 per booking once full payment has

been received and/or documents have been processed.  Cancellation received within 2 weeks of

departure are subject to a penalty of $300 per person as well as any additional fees imposed at the

discretion of the suppliers.

REFUNDS: Refund requests (if applicable) must be received in writing within 45 to 60 days (pending on the Vendor Policy) prior to the date of travel.  Please allow 6-8 weeks for processing and include any unused documents with correspondence.

 

         CONTACT REBECCA FRANCIS PERSONALLY AT 202-726-2684 IF YOU HAVE ANY QUESTIONS.

                             FAX FORM & CREDIT CARD (FRONT AND BACK) AND A PICTURE ID TO:

                                                   REBECCA FRANCIS TRAVEL PRO

                                                                       202-726-7188

 

                                       OR MAIL COMPLETED FORM AND A PICTURE ID TO:

                                                                  R Francis Travel Pro  

                                                             4625 13th Street, NW, #304

                                                               Washington, DC  20011

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