This form must be FULLY completed and fax to (888) 978-1155 before tickets can be issued.

Dear Sir/Madam,

This is to confirm that, in keeping with all applicable laws, we are instructing DISCOVER TRAVEL, to issue tickets against the credit card listed bellow.It is expressly understood that this amount charged does not include or constitute any additional fee related to our acceptance of credit cards as a form of payment unless permitted by law.

We further represent the credit card holder stated below has authorized this transaction and that we will indemnity and hold DISCOVER TRAVEL, harmless with respect to these instructions.

Passengers:

1.___________________________ 2.___________________________

3.___________________________ 4.___________________________

Booking Locator: ____________________________

Card Holder Name: __________________________ Home Phone: ____________

Credit Card Type: Visa / MasterCard / AmericanExpress / Discover / 

Credit Card No : __________________________ Exp. Date: ____ /____ ( mm/yy)

Charge amount Passenger: 1._________  2._________ 3._________ 4._________

Total to be charged :____________ In words ________________________________      

Billing Address:___________________________________________________

State : _______________ Zip/Postal code : _________  Country : ____________

Issuing Bank : ______________________________

Customer service phone no: _________________ (Displayed on backside of your card.)

Card holder signature: _________________________________