Please complete the Credit Card Payment Form below and fax to 1-425-984-8054.

* THE CARDHOLDER MUST SIGN THIS FORM IN ORDER FOR THE CHARGE TO BE PROCESSED.
* I HAVE READ AND I UNDERSTAND THE TERMS AND CONDITIONS.
* I HAVE REVIEWED MY ITINERARY AND I VERIFY THAT ALL INFORMATION IS ACCURATE.
* IF ANY INFORMATION IS INCORRECT, INCLUDING BUT NOT LIMITED TO PASSPORT NAMES, TRAVEL DATES, ITINERARY DETAILS, ETC, PLEASE CALL 1-800-2-FRANCE (800-237-2623) PRIOR TO SUBMITTING THIS FORM IF ANY INFORMATION IS INCORRECT.
* I UNDERSTAND THAT PENALTIES, TRAVEL DELAYS, OR CANCELATIONS MAY APPLY SHOULD ANY CORRECTIONS NEED TO BE MADE.
* I UNDERSTAND IT IS MY RESPONSIBILITY TO OBTAIN THE NECESSARY DOCUMENTS FOR TRAVEL INCLUDING PASSPORTS AND VISAS.
* BY SIGNING BELOW I AGREE TO ADHERE TO THE TERMS & CONDITIONS OF THIS TRANSACTION.

Booking Number: ________________

Card Holder Name_________________________________________________________________

Card Holder Billing Address- Street________________________________________________

City________________________________State_____Zip_______

Credit Card #_________________________________________ Security Code _______ Exp _______

Visa, Mastercard, Discover & American Express Credit Cards gladly accepted, Debit Cards are not accepted.

I authorize $_________________________________________(enter amount) to be charged on my credit card.

Card Holders Signature ________________________________________________Date____________

I have been advised of and chosen to ___ACCEPT ___DECLINE Air France Holidays Travel Insurance.

Please note that if you did not book insurance when you submitted your request an additional amount will be due should you wish to add Travel Insurance to your reservation.