Aljusant Travel Credit Card Authorization Form

Fill in the form, then click the "Print This Form" Button below and fax the signed form with the required documents mentioned below to 302-656-1724

CREDIT CARD INFORMATION

Name

 (as shown on CREDIT CARD)

Credit Card Type   

VISA   MC  AMEX  DISC  OTHER

Credit Card No

 

CCV

                           Exp Date   /  

Billing Address


 

Card Holders Home Phone 

BOOKING INFORMATION

RECORD LOCATOR        

NAMES OF ALL PASSENGERS TRAVELING USING THIS CREDIT CARD CARD 

 

 

AMOUNT  TO CHARGE

 

Last Name

First Name

Adult

 Child

Infant

1.

2.

3.

4.

Total Charge = USD

        I hereby authorize Aljusant Travel to charge my card in the amount of USD for payment of tickets for all the above passengers.


____________________________________________________
SIGNATURE OF CARD HOLDER MUST BE SAME AS SHOWN ON CARD

  • All sections, calculation and customer's credit card billing address must be completed on this form before tickets can be issued
  • An imprint and signature from the authorized signer must still be obtained for corporate cards
  • Delivery fees will only be charged once
  • We accepts Visa, Master Card, American Express and Discover credit cards.  We will obtain the approval on the credit card.
  • We do not accept Debit Cards, Third Party credit cards or Credit cards issued outside of the USA.
  • AJ Travel may appear on the cardholder's statement.
  • Note: In addition to any AJ Travel and airline penalties , 4% of total charges may also be non-refundable on any cancellations.
  • AJ Travel must be notified of any changes: 1-888-VIAJERO
  • Required documents: record locator, copy of itinerary, copy of cardholder's passport or drivers license and copy of credit card.