Credit Card Authorization Form | Travel With Teeka

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Get In Touch

Beach Waves

First name*

Last name*

Phone*

Email*

Card Type (Visa, Mastercard, Amex, Discover, etc.)*

Card Number*

Expiration date*

CVV*

Street address to match card*

City to match card*

State to match card*

Zip Code to match card*

Purpose of payment*

Amount you want charged today*

Did Teeka Kapree offer you travel insurance? *

Yes

No

Did you accept or decline the travel insurance?*

Accepted

Declined

If you declined the insurance, are you aware of the penalties ?*

Yes I am aware

No

N/A I accepted the travel insurance

Todays date*

Signature

Sign in the box or use the keyboard to type.

Signature field is empty.

Please upload picture of your ID

I authorize Travel With Teeka to charge my card in the amount above, listed today.

Travel With Teeka

To book any of these deals, please shoot me a text at 856-655-8794
All prices are subject to change until deposit is made

travelwithteeka@gmail.com

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