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

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 Service Waiver 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.

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