Credit Card Payment Authorization Form

Res. Agent

Card Holder's Name* :

Card No* :

Expiration* :

Billing Address For Credit card* :

Phone Numbers :

Home

Office

Cell

E-mail* :

Passengers* :	1.	2.
	3.	4.

Card Type :

  American Express

  VISA

  Master Card

Payment in ($)* :

 By checking this box, I accept full liability for the charges described herein. Payment in full will be made when billed in accordance with the standard policy of the bank issuing the card. I am aware that these tickets are non refundable and subject to a penalty from charge as specified by my travel agent.

In lieu of my credit card imprint, I……………………………………………………………………..here by authorize Lawson Travel, Inc., their representative and/or respective airline to charge my Credit Card for the amount shown above for my airline ticket. I have received the complete itinerary and have read and agreed to it. I am well aware that airline tickets have a refund/change penalty. In any event, if any changes or request for refund occurs on my ticket, I am authorizing Lawson Travel to charge a penalty separately to my credit card or credit my credit card after the penalty amount has been deducted. I am fully aware and have read and am agreeing the refund policy/terms which are on  Lawsontravel.com (Company website)

Card Holder’s Signature: _________________________      Driver License Number: ____________________

All Credit Card payments must be supported by copies (front and back) of the Credit Card used and a Federal ID such as Driver’s License or Passport.    **Most airline tickets are Electronic Tickets delivered by Email or Fax. **

This form must be completed in full and all information must be true and correct in order for ticket issuance to be complete.

Lawson Travel · 1140 Empire Central Suite 620, Dallas, TX 75247

Fax this form to 214-631-2464