Credit Card Authorization

CREDIT CARD AUTHORIZATION
This website is not a secure payment platform. Please do not send full credit card details on this page.

Please select the box below and complete the following information:

By checking this box I authorize Brentwood Travel to charge my credit card on file for the payment listed below.

Name:

Phone:

Last 4 Digits of card on file

Expiration Date

Billing Address: City, State, Zip Code

Amount Authorized

Name of Brentwood Travel Consultant

If "Other" was selected, provide the name of your Brentwood Travel Consultant here

Description or booking number

Free Text

I understand that multiple payments may be needed to complete the full balance due, and that my information will be saved on file for future approved transactions made on my behalf.
I have reviewed, understand and agree to all potential Cancellation, Refund, and Surcharge Policies and Fees by the suppliers within my reservation.
I understand that Brentwood Travel may assess an additional 15% processing fee for changes and/or cancellations, regardless if cancellation insurance has been purchased.
I understand that should there be any issues with the credit/debit card used for my charges, I will be held responsible for all expenses agreed upon and will not hold Brentwood Travel liable.
I have been advised of Brentwood Travel's Terms & Conditions and agree to all conditions.

Please check the following box:

By checking this box I am stating that I have read and understand the above statements.

Cardholder Signature

Date Signed

**If your agent has advised you to use a UCC Form (Universal Credit Card Charge Form) then CLICK HERE to download**