Credit Card Authorization Form

Date *

First Name *

Last Name *

Payment Authorization

I authorize Downunder Travel Ltd and/or their appointed suppliers to charge my credit card the total amount shown here.

Credit Card Type *

For your security, please call your Consultant with your credit card number.

Visa

MasterCard

American Express

First Name *

Last Name *

Street Address *

Address Line 2

City *

Postal / Zip Code *

State / Province *

Country *

Phone Number *

Email *

Seat Preference *

Dietary Restrictions *

Yes

Emergency Medical Insurance *

Trip Cancellation Insurance *

Additional Information

I agree to the Terms and Conditions