VERIFICATION OF CREDIT CARD AUTHORIZATION FORM

Please note that we cannot issue travel documents unless this form has been completed and returned to our office.

I, __________________________________ (print name) hereby authorize Trofino Tri-Star Travel, Inc. or, vendors used in conjunction with the vacation package to charge the amount of $________________   to my:

VISA___     MASTERCARD___    DISCOVER___    or AMEX______    
 NO DEBIT or CHECK CARDS ACCEPTED

This payment represents:  Deposit_____   or  Final Balance_______

Must complete the Following:
Account Number:_______________________________________      Exp. Date:________   
Verification Code:____________
Number of Passengers Traveling:____________                                                     
Trip Dates:_________________ 

Name as it appears on the card:___________________________________  (Print Name)

Billing Address:
Street:__________________________
City:___________________________           State:__________       Zip Code:_________
Contact Telephone Number:___________________
E-Mail Address:_________________________

(MUST INDICATE ONE CHOICE):
I have been notified of Insurance options and by signing below indicate my election to (MUST INDICATE ONE CHOICE):
1. Accept Insurance:___________ (Insurance may be purchased from our home page)          
2. Decline Insurance:___________    

REQUIRED:      
YOUR SIGNATURE:____________________________________           Today's Date:______________
**Fax this complete form to: 814-535-1334