SUBMIT AND AUTHORIZE DEPOSIT/PAYMENT INFORMATION TO ADAMS GLOBAL TRAVEL
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*Please fill in all all Fields and sign in the signature box before submitting this form
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Your Email:

Trip Date:

Booking number or Last Name:

Resort/Ship Name:

CREDIT CARD INFORMATION
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If you are using a Debit Card with a daily spending limit, it is your responsibility to contact your bank to give them permission to authorize the transaction. If they require the name of the vendor and you are unsure as to who that is, please contact Adams Global Travel.
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Payment Type:
DEPOSITPAYMENT
Your Name as it appears on Credit Card:

Billing Address:

Billing City:

Billing State:

Billing Zip Code:

Billing Phone Number:

Credit Card Type:
VisaMasterCardDiscoverAmerican Express
Credit Card Number:

Expiration MM/YY for Card:

CVC Code on Card: (3 digit for Visa, MC, Discover – 4 for American Express)

Amount to Charge: $

Trip Insurance Accepted:
YesNo
By declining trip insurance you understand that parts of your trip may not
be fully refundable or the type of cancellation coverage available will be restricted.
YesNo
I accept and authorize all charges for my Trip

I acknowledge that all the above information is correct. By Signing in the box below
I am giving authorization to Adams Global Travel and or the supplier to charge my credit card
for the amount listed above.
[signature* signature-523 cols:444 rows:193 attachment]
Todays Date: