Cheri Ramberg

519 848 2566 or 519 831 7928

Credit Card Authorization

For your protection, each time you authorize us to charge an amount to your credit card, we require you to complete and sign this form indicating your approval to debit your credit card with the amount authorized.

All fields marked with asterisk* are mandatory

Trip Information

Traveler's Names

Your name should read as stated in your passport

Contact Information

Credit Card Information


Visa / MasterCard / JCB / Switch / Solo

Flip your card over and look at the signature box. You should see either the entire 16-digit credit card number or just the last four digits followed by a special 3-digit code. This 3-digit code is your Card Security Code.

American Express Credit Card Users

Look for the 4-digit code printed on the front of your card just above and to the right of your main credit card number. This 4-digit code is your Card Identification Number (CID). The CID is the four-digit code printed just above the Account Number.

Credit Card Billing Details

Please sign in the box below. With your mouse, simply click and hold down the button and draw a replica of your signature. On a touch screen, use your finger to draw your signature.
Date: Feb 19, 2018
No other persons are authorized to make charges on said card without my express authorization. In the event that any other passengers in my cabin make charges against this card, I hereby agree to indemnify and hold blameless, Vision Travel Solutions for any and all such charges, claims and liability related hereto. I agree to immediately notify the said travel agency of any changes to the above information.